If today’s “virtual care” isn’t the answer for people with chronic illnesses, what is it?


MedCity News

The Covid-19 pandemic has pushed the medical industry to offer high quality remote care, and many patients are finding it easier than ever to see their doctor. This is undoubtedly a positive development, but not a paradigm shift. Modern virtual care is not the revolutionary change the industry needs.

Today’s “virtual care” uses technologies – video, chat, security, privacy – to mediate the temporary relationship between overworked doctors and patients. However, it does not take into account that most chronic treatments are actually performed outside of that relationship, in daily life, allowing patients to make daily health decisions without adequate assistance.

Where does modern virtual care go wrong?

The virtual restoration 1.0 – which we can imagine as a first attempt – offers the patient considerable advantages. The absence of doctor visits, especially for people who are busy, uncomfortable, or have mobility problems, is a major improvement over the standard assumption that appointments are in person. It’s also a great solution for regular check-ins.

However, in more complex cases such as chronic illnesses, virtual care encounters the same fundamental problem as analogue care. Chronic care patients require 24/7 support, but only receive a few minutes of expert care per month. You are then released into the world to make complex medical decisions of your own.

For example, consider the case of a person with type 1 diabetes, a condition that affects over 1.6 million Americans. Research by Stanford University scientists found that they make an average of 180 follow-up diabetes-related decisions a day.

Leaving these people without support in making these decisions just doesn’t work. Eighty percent of people with type 1 diabetes do not meet the recommended HbA1c target and are two to three times more likely than other members of the public to experience fatigue, anxiety, stress, and depression.

The human ability to truly support people with type 1 diabetes in their daily lives is incomprehensible – and that’s just one condition. There are simply not enough professional doctors in the world to provide this amount of care, no matter how much technology is made available to streamline their workflow.

Center the patient

In order to really improve the care of people with chronic diseases, the care system needs to be rethought and not simply digitized the traditional analog model of health care. One concept that the current system neglects is that people with long-term illnesses are already acting as their own care providers in many ways. They seek expert advice through their interactions with the medical facility and then learn through trial and error what works for them.

The future – Virtual Care 2.0 – must build on this understanding and focus on a new KPI: patient autonomy, the ability of a person to treat themselves effectively and to feel confident in their decisions.

What has to change in order to get to virtual care 2.0?

We have the data, technology, and ingenuity to dramatically improve patient autonomy, but the industry must change in three critical ways to make it happen. The first is respect for the patient. A paternalistic “doctor knows best” attitude often permeates the entire nursing process to the detriment of the patient. While many industries have been obsessed with consumer engagement for over a decade, the medical industry is still dependent on “adherence” and “compliance”.

When you adopt an attitude where the patient is not just a “co-driver” in their own care, but the driving force, you get better results and move the industry forward.

The second area the industry needs to work on is curiosity. Rather than blaming patients for failing to adhere to suggested solutions, we need to investigate why they are not following recommendations (often because they cannot) and rephrase problems in a solvable way. This will take us well beyond purely medical problems into the complex and chaotic world of reality. Only by addressing the challenges patients face – medical and others – can industry hope for effective solutions.

The third area to change is humility. We know far less than we think about many chronic diseases such as diabetes, let alone about the people who live with these diseases. For example, the popular perception of people with diabetes as being unconcerned about their health or “fat and lazy” does not reflect a person’s lived experience – many people follow their doctor’s instructions to the letter and still do not achieve their desired health outcomes. The arrogance of the innovators is a major obstacle to innovation here.

The future of care is patient-centered

Merely expanding the medical status quo into the virtual world does not solve some of its deepest limitations, especially in chronic care. Using technology to enable patients to effectively manage their own care will produce better outcomes and potentially end the unacceptable trend of poor outcomes in chronic care.

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