Puneet Seth is a practicing family physician in Toronto, part-time Assistant Clinical Professor (Adjunct) in the Department of Family Medicine at McMaster University and Chief Medical Officer of InputHealth Systems
As someone whose life is deeply entrenched in health care technology, both as a physician tinkering with a variety of digital health tools in my own practice and as an entrepreneur helping to build these tools, I've become acutely aware of the growing trend among health professionals in viewing "virtual care" as some kind of magical endpoint that will solve all of the woes of health care.
A recent CMAJ News article illustrates how attitudes toward the broad use of virtual care are often bullish. In the context of breaking bad news to a patient, it was suggested that it is "not whether certain types of news should or shouldn’t be delivered in person — it’s all about how you deliver it." I disagree. While I can appreciate that the alternative is no message being delivered at all (which may be the case in certain parts of the world), I feel we are missing the forest for the trees by approaching virtual care in this way.
For the purpose of this blog, I will broadly define virtual care as the usage of a wide range of technologies that support access to and delivery of care. It can be as simple as a digital exchange of information between a care team and a patient, such as the sharing of lab results via a patient portal, which is becoming more commonplace (though seemingly ever so slowly). It can include secure video conferencing, which is often what people think of when we talk about virtual care, though arguably, this may be its least efficient and scalable use. It can also be far more complex, such as the use of vital sign monitoring devices to track blood pressure and oxygen levels on a patient who may have recently left hospital following an exacerbation of their respiratory condition, alerting the care team of a change in their condition.
As the health care system evolves to include an increasing number of technologies and as necessary validation data emerges to guide decision makers on where and when to use such tools, "virtual care" will simply be synonymous with health care. However, just because a facet of care delivery can be virtualized, doesn't mean that it should be.
In health care, more so than in most other industries, decision-making on where, why and how novel technology is applied must take into consideration more than just the dollars and cents, it must also consider the humanities aspect of medicine. The consequence of not doing so will further drive out empathy and humanity from health care.
Dr. Victor Montori, an endocrinologist from the Mayo Clinic who has famously championed patient-centric care, recently gave a heart-warming talk at the Women's College Hospital in Toronto on the need to return to "careful and kind medicine" at a time where health care in Canada is becoming increasingly industrialized. One of his salient messages was critical of some of the new technologies rolling out in the industry. He remarked that many of the "patient engagement" tools being implemented in the US, under the guise of improving patient access and experience, are simply creating cost savings for the system without providing a clear benefit to the patient. Do we consider having a patient come to a clinic to see a doctor on a computer screen - not because there wasn't one available, but rather simply because it was cheaper - a successful use-case of virtual care?
While there is no denying that it can certainly save money, prevent some unnecessary in-person visits and help bridge gaps in access to care, I believe the most compelling quality of virtual care is its ability to let us (health care providers) do our jobs better in person. Through thoughtful and intelligent application, virtual care has the opportunity to improve our definition of care by extending the hand of the health care system beyond the walls of the hospital and clinic. Rather than replace in-person care, I propose it will afford us the breathing room and tools to make human-to-human interactions more meaningful and humane.
As innovative professionals continue to push for the integration of new technologies into routine care, my hope is that we all take a moment to pause and think about the kind of care we wish to see for ourselves, our loved ones, and our patients.