The Uber Doctor
Care On Demand is not a real thing.
While the institutes of technology and commercial enterprises are teaming up to make life easier for the upper middle class through apps and financial incentives to commodify everything - physician-based care is one field that I stand for strongly as "un-techy".
Sure, technology innervates the threads that weave medicine into its tapestry. Without it, our health sciences would be nowhere close to remote surgery, minimally invasive monitoring, and mapping the human biome, and I'd probably be drowning in paperwork and outdated information. And we now have the wonderful capacity to improve health information transmission through photos, emails, phone calls and video visits.
On almost every level technology is making us better at delivering, understanding and receiving healthcare. Almost.
Care on Demand - in this age of the tech startup industry - implies immediate, uncommitted, evaluated contact, without concern for the provider as a human. And this is where I put my foot down.
Because reduced paperwork, improved technical skills, access to biodata and a virtual connection are not the definition of care.
Effective care comes through the efforts of patient and doctor to understand one another over time.
Authentic care is offered through the sharing of the common experience of being in this together.
Care cannot be demanded.
But, just as we see with Yelp, Uber and AirBnB - the on-demand economy - the urge to "Uber" our healthcare system seems to be on the rise.
Don't know what I'm talking about? See:
Want a doctor right now? Find one available online. Check out the reviews. Connect through the app. Pay through the app. Get your service as you prefer it. On demand. No need to cultivate a relationship, a context, an understanding of each other. Just get your answers and review your satisfaction. Preferred answers move certain doctors to the top. The cost? Way less than seeing them in person.
Sounds great, right? In the new "sharing economy" - the on-demand world - no one can hear you working.
To bring doctors into the fold of health tech turns the practice of medicine into a penny hobby on a soapbox.
On-demand healthcare is not a place to find financial stability nor a satisfying profession.
Anne-Marie Slaughter articulates the impact of this economy in a way I have not been able to:
"For an Uber driver to earn extra income whenever he or she has time is one thing. But drivers who are actually trying to make a living often receive below-minimum-wage pay and no benefits - no health insurance, workers compensation, unemployment insurance or retirement plans"
Signing up to be part of crowd sourced commodities, is signing up as a contract worker/consultant without the financial compensation that goes with those careers. To be clear, I am not against convenience based commodity apps. I use Uber in India, because it's way more efficient than hiring taxis. I stay in AirBnB's because I enjoy spending time away in homes and in communities. I sure do like services I can pull up on my phone.
But crowd-sourced, on-demand apps are no place for well-trained physicians to be seeking alms.
Why? Because the convenience of seeing patients online in an on-demand context comes at a financial loss to the provider. In addition, to increase user acquisition and stay competitive in the market, compensation to the providers is based on availability, reviews and people pleasing. This makes for a tenuous healthcare environment.
Slaughter goes on:
"Some job is better than no job, but the inequities are stark. As New York magazine reports, a platform start-up that connects housecleaners to customers ends up employing homeless people to clean the homes of the prosperous. Even as the entrepreneurs succeed in attracting hundreds of millions in investments from Silicon Valley investors, they do not provide the pay and benefits necessary to allow the service providers they profit from to rent a home of their own."
Translate this into healthcare: The fiscal realities of medical resource management and practice maintenance costs for physicians is the elephant in the room. I like this particular Canadian doctor's financial disclosure, as he separates out his private practice income from the hospital practice income - He calls out the fact that private practice family doctors are already not compensated to the level of their educational and time investment.
Read: Primary Care Physicians have to love this day job to do it. We certainly don't need to be pitching our services for the tech industry to leverage to the public as "on-demand, low-cost", unless we're getting a larger piece of the pie that we've been filling.
We have arrived in the new corporate landscape. This is the old boys' club in new clothing.
Nothing wrong with a little spare cash and an nicer ride to the hotel, but be wary of the wolf that looks fluffy and meek.
Within health tech, there is plenty room for the development of virtual connections with your trusted doctor, as a medium for making care providing easier, like Medeo where doctors bill equally in fee-for-service costs to BC's healthcare system, but remember that even this is not a philanthropic venture. In any Investor-Backed start ups, there is always a stock value to answer to.
As a physician, don't drink the Kool-aid that tells you health tech is about anything but the valuation for the exit.
As a patient, don't let your healthcare relationship be administrated solely by the slick user experience and the hoodies of silicon valley.
There is a lot to be gained by technological advancements in patient-doctor interaction, but being a fool for this era's gold rush is not one of them.
You might be able to get auction off your question for some professional or crowd-sourced information, but this my friends, is not care. Never substitute information for informed care.
Doctors are not simply slot machines for answers. We are not private investigators trying to hack the body for the knowable. We are here to walk with you through illness and the better we know you, the better solutions we will have.
- Sometimes being a doctor is about delivering the least desirable news that has no solution but to endure it, and holding the room up while you process that.
- Sometimes it is finally taking a breath of relief after waiting for a treatment to work and the only way to know that it did is when you show up to let us know, to share your joy.
That kind of care is not a commodity. Heck, it's not even a service. It's a vocation.
The more we commodify doctors, the less satisfied we all will be.
We don't need to scale every industry. I believe that small is beautiful; something that Judy Wicks taught me was possible.
The doctors that serve you best embody many things, but for one:
"A doctor who recognizes the patient in the face of sickness, who respects the patient's strength despite the fear, who accompanies the patient through the territory of illness that the doctor knows well, and who honours the meaning of the patient's suffering provides not just knowledge of diseases but knowledge of the direction toward either health or the ability to live authentically without health."(Italics added) - Rita Charon, Narrative Medicine
The best way to build this is not through the rise of nouveau tech, but through the small meaningful connections built over time - to be collaborative; To recognize change and catch it or congratulate it.
Stay small. Build authentic relationships. Support your community.
Change doctors don't not chase the white rabbit. They know what matters. They use technology to assist a health relationship, not to replace it.