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Dr. Kacir's ADHD Blog

The art of medicine: only peripherally related to ADHD

I joined Linked-In a few months back and haven't quite figured out what it's good for, but they do send me interesting articles about health care, mostly from the business perspective.  I read two of these articles today and was somewhat amused to find that their views of medicine were near polar opposites... and both conflicted with my own. 
 
The first was written by "a former hospital executive and consumer health behavior researcher" with a Masters in Public Health.  His premise was that doctors need to change their view of compliant patients (who follow their advice and consult them about health choices) as being those with the best health.  His reason for criticizing this view is that some of the healthiest people around are those with a marked distrust of doctors and medicine. Those of them who nevertheless placed a high value on maintaining their personal health and devoted significant time and energy to relevant pursuits were more satisfied with their health status than were traditionally defined compliant patients.  The author suggested that all health care professionals (and he included himself as one) "incorporate the patient’s perspective into outcome and satisfaction measures."
 
The second article was an interview with Eric Topol—the chief academic officer at Scripps Health, who was touting the many digital diagnostic tools now available, although not yet approved by the FDA.  He urged doctors to educate themselves about all these technological gizmos and to start incorporating them into their diagnostic and therapeutic regimens.  Among the digital advances he mentioned were electrocardiograms with a phone, glucose levels via  touch screen and genomic sequencing to determine certain types of drug sensitivity for each patient.  He summarizes his conclusions as follows:
 
We need a Khan Academy for doctors: captivating 15-minute videos on genomics, on wireless sensors, on advanced imaging, on health information systems. These things can revive the excitement they felt as premeds, when they first decided to go into this field. If we can get practicing physicians up to speed and really inspired, maybe we won’t have to wait a generation. I shudder to think about waiting 10 or 20 years for this transformation to occur.
 
You can see that prioritizing the "digitization of medicine" over current practice, fails to take into account the patient's perspective touted in the first article.  Practically speaking, if the doctor is concentrating on the details and logistics of technology for diagnosis and monitoring, how much attention is left to listen to the patient's needs and desires?  Doesn't this focus further compound the skewing of outcome measurement toward the goals of the health industry rather than those of the individual patient?
 
My personal perspective on the digitization issue is that it has nothing to do with the excitement I felt as a premed.  My goal was to have expertise that allowed me to help people to feel better after our interaction than they did beforehand.  The more experience I gained, the more apparent it became that the most important diagnostic tool I had was the ability to listen.  At times, that ability is the most effective treatment available as well.  Digital media give me more data to interpret, change the way I record my actions and add to the information I can convey to patients, but they do not help me to empathize or communicate.  Those skills are what will lead my patients to feel better... and that is the outcome I seek, regardless of how it is measured.
 
In my ADHD practice, evaluation and treatment is based almost exclusively on my patients' impressions and reports.  The goals of therapy are the goals described by my patients for themselves.  I try to stay current on the technologies available to help them, but I rely on their expertise in their own experience to inform the process we go through.  The success of my practice is the outcome measurement I use, so perhaps I am utilizing my patients' perspectives for such measurements after all! 
 

4 Comments to The art of medicine: only peripherally related to ADHD:

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Robert Lee on Wednesday, February 8, 2012 8:24 PM
Hmmm... The author of the first article noted that people who visited the Doctor's office more often were less satisfied with their health than people who rarely had to visit the Doctor. Really? Makes sense I guess; I would hate my truck if I had to take it to the mechanic all the time for repairs! But wait, the author said 'compliant' patients and then compared these to "...those who have a marked distrust of doctors." I am one of these latter types of people, however, when I DO need to visit the Doctor's office I do as I am instructed (comply) by the Professional! So, am I a 'compliant' or 'non-compliant' patient? As for Mr. Topol's article... Tools do not a Doctor make! If a doctor lacks the correct 'bed-side manner' no amount of digital technology is going to help! I instruct advanced concepts for my industry and one of the big points is that if a person can perform well with the 'old standby' tools they can perform well with the new technology as well; but a new tool isn't going to make someone a better technician (or doctor)! I love your blogs Dr. Kacir!
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Lauren Kacir on Thursday, February 9, 2012 11:08 AM
Thank you for the compliment! Your questions about being compliant or non-compliant is a good one from the point of view of this article. I think that the author would put you in the latter class because of your distrust of doctors. I suspect that if your doctor did not earn your trust despite his or her profession, you would be unlikely to comply with any suggestions. Therefore, I also thank you for your trust and your implied approval of my employment of old and new technology!
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Julie on Friday, September 21, 2012 9:39 AM
Thank you! Themes of compliance, trust, technology, and change permeate the revived discussion of doctor:patient relationships. And the best tool is our ability to listen with our ears and our hearts.
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Dr. Kacir on Monday, September 7, 2020 3:12 PM
8 years later, and I have just cleaned up all of the spam comments. I figured that I would actually look back at the original blog. I still agree with my own comments about the issues of "meeting patients where they are at" and about the benefits (and lack thereof) of technology based diagnosis and management. On the other hand, the two articles are no longer as diametrically opposed as I thought they were. Now, when I am working with patients who are not maximizing their health through a physician, but are utilizing "life hacks," they are frequently using the very interventions touted by Eric Topol! They are digitally tracking blood pressure, pulse, and sleep and asking me to help interpret genetic testing. Thus, 8 years has revealed that it is more important that I be aware of the technologies that Eric Topol mentioned, than that I be technologically adept at working with them. It is extremely useful for me to be able to review the data that a patient has gathered. Furthermore, these patients might have been termed non-compliant by other physicians, since they are following their own monitoring rather than one that was recommended. One thing that hasn't changed, however, is that genetic testing has not proven helpful in choosing ADHD medications for any given person. Regardless of what the labs say, optimal treatment still requires trial and error with different prescriptions.
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