Digital Health vs Digital in Health: A Clinician’s perspective

As we bid adieu to 2024 and welcome 2025, I am delighted and excited to directly witness the radical transformation in healthcare delivery, due to deployment of digital technology. However as a septuagenarian, trained in the BC era (before computers not before Covid!), I am concerned that perhaps inadvertently, the tremendous weightage given to digital is putting health in the background. There is a danger that the focus of healthcare is shifting, from what an individual patient really wants (which itself is a function of multiple inconstant variables) to the perceived needs, determined by the powers that be, having multiple interests. A detailed multi-disciplinary social appraisal of consequences of mass-scale rapid use of digital health (DH) may point out several concerns, to which hard core DH evangelists may be turning a Nelson’s eye, due to misplaced enthusiasm. A digital health solution is not a true solution unless it is cost effective and universally available to anyone, anytime, anywhere. Emphasis on RoI results in proactive measures to enforce behavioral modification, suiting an organization’s ends. At the end of the day, there is no free lunch! Several decades ago, I was clearly told when a proposal was being evaluated, “We are answerable to our investors.”

In a world where algorithms make diagnoses, wearables track vital signs, and robots are remotely controlled to perform surgical procedures, will doctors of the ensuing decades become depersonalized humanoids. The writing is on the wall. Sir William Osler’s observations 150 years ago “… the good physician treats the disease, the great physician treats the patient who has the disease,” is becoming redundant. Technology today is working overtime to guarantee patient safety, quality improvement and ultraprecise management of disease processes. Proactive measures are promoting good health.

However, infrastructure alone will not suffice. Doctor-patient communication is a dynamic, complex process, a multi-dimensional, multi-factorial phenomenon closely related to the environment, in which an individual’s experiences are shared. Self-learning chatbots and humanoids competing with humans, to display empathy and sympathy perhaps may be available, in the foreseeable future – only if the powers-that-be give appropriate weightage to this now. A doctor has always stood for – “To cure sometimes, to relieve often, and to comfort always.” Will this continue, even in my lifetime?

Doctors in India, have the greatest resource for continuing medical education, our infinite variety of patients. If only we are willing to learn from each single patient, each doctor has the potential to develop into an expert system, capable of constant and instantaneous upgradation. Imagine if we supplement this with digital learning tools. The inherent untapped dormant expert in each of us would transform exponentially. Exercising clinical judgment and clinical wisdom contextually, customized for the individual beneficiary, in every single consult, would probably convert tens of thousands of beneficiaries to be evangelists par excellence, promoting DH. Using AI to complement this would result in an unbeatable combination.

Personalized clinical judgment is often giving way to deployment of standardized care to ensure consistency and predictability. However, one size does not fit all. There is also a gap between scientific evidence about what works best and the care a patient receives. A doctor may follow the results of one study, disregard the findings of a second, and be unaware of a third. AI would address this.

Companies come up with new technologies, supposedly beneficial to humankind. Aggressive digital marketing can make one feel that one should only use the iPhone 16 Pro! Unfortunately when this approach is extended to healthcare, it could have dire consequences. In the absence of unlimited universal health coverage, it is most devastating for a patient without resources, to be led to believe (based on AI recommendations) that if he/she had access to proton therapy or (CAR) T-cell therapy, his life could be saved. After all a recommendation is not a solution unless it is universally available to anyone, anywhere, anytime.

Clinical trials and systematic reviews have limitations. Appraising evidence requires considerable skill. Long-term follow-up has led to recalling of several national policies. Mammography screening is one such example. Reports now suggest that benefits are restricted to a highly selected group. Mass repeated screening sometimes has even produced detrimental results. As risks may outweigh benefits, the European Breast Guidelines recommend against annual mammography.

Providing TLC (tender, loving care) should still remain the raison d’etre for a doctor’s existence. One needs to get into the brain of a patient (literally and figuratively), and make an attempt to understand what exactly the patient and the family want and – in the real world – find out if they have the wherewithal to follow recommendations given by the most sophisticated AI program, in the universe. At this point of time, there is no algorithm which has been developed without bias, tested, and validated giving sufficient weightage to what the patient really wants and can afford. The geeks from Gen Alpha and Gen Z use gizmos to address multiple specific problems, without necessarily seeing the big picture. Today, distance is meaningless. Geography has become history! If only DH could be renamed CCDH (compassionate, caring digital health) the planet in the DH era would truly be a utopia.

After all “To err is ChatGPT, to forgive is human!!”