Computercare: The no touch doctor visit

If you are older than 50, you probably remember this kind of doctor visit.

First, you actually saw an MD or DO. The visit seemed to last a lot longer than it does today and the doctor actually faced you while asking questions. There were no electronic medical records so documentation varied from a 3x5 card, a chart or, in some instances, a scrap of paper

First, the medical assistant, the front desk person, maybe some back office people would each hand you a clipboard and you would have to enter the same information on each. Then, the clinician would ask you questions that typically included chief complaint, history or your illness, past medical history, family history, social history (what is your occupation? Not all that social determinant stuff) and review of symptoms without reading most of the information you put on the forms on the clip boards.

Then, he or she (most likely a he in those days), would perform a physical examination with those tools in the black bag, and, imagine, the laying on of hands.

The differential diagnosis and working diagnosis came next and then a therapeutic plan was recommended, and you had tests, drugs or a procedure. It was rare to get no treatment. Then, "I want you to come back in six weeks to see how you are doing. And, thanks for the Whitman's chocolates."

Now things are a bit different.

Primary care player Forward unveiled this week what it has been quietly working on the past two years—self-serve CarePods that use artificial intelligence to screen and diagnose health conditions.

The new CarePod modules are being deployed in malls, gyms, and offices starting in the San Francisco Bay Area, New York, Chicago and Philadelphia. Forward plans to more than double its footprint in 2024, the company said.

Fast forward to Computercare. Instead of Googling symptoms to when feeling an ailment and landing on an incorrect diagnosis, AI could soon provide accurate diagnosis without needing to go to a doctor’s office.

A new benefit for Amazon’s employees in the Seattle area is a virtual medical clinic that also offers in-person healthcare services. another addition to the Amedzon menu of services.

Already, the U.K. is working on that capability, the Daily Beast reported. An AI-powered healthcare system called Babylon has been integrated into the National Health Service and works to find patients with urgent needs and separate them from those with lesser illnesses.

Similar to Googling symptoms or using a symptom tracker like WebMD, Babylon asks about symptoms and then prods for other questions to determine if over-the-counter medications are needed or if it’s time to go see a doctor. The application is especially useful in rural or remote areas where access to a doctor is reduced.

By the time you see a "provider" .you have entered your data using your digital ID into the internet of medical things, including your DNA genealogy and family tree, remoting sensing information, patient reported outcomes, information about your social determinants of outcomes, chat transcriptions with an avatar or a bot, a an analysis of unstructured data on social media and smart speakers in your house, car and mobile device.

There is no real physical exam since technology can pretty much see through your skin and analyze how your body parts are working. The stethoscope around your doctor's neck is really just for show.

The practitioner gets the most probable diagnosis using AI driven decision support tools and recommends an evidence based treatment plan. The care navigator takes it from there to be sure you are educated, have a good patient experience, engaged and enabled to change your personalized well-being behavior. Oh , thanks for the 5 star rating on Yelp and Google.

Another big trend in touchless monitoring and technology is voice AI that works as a smart solution for doctors by replacing human-centric tasks with digital voice. The intelligence of voice AI eliminates the traditional process of creating prescriptions, connecting, and interacting with patients while making the entire process touchless.

Then, there is the metaverse, or, in the case of sickcare, the medaverse. Facebook?(FB )?plans to hire up to 10,000 workers in Europe to build a "metaverse " that will combine virtual and augmented reality technologies in a new online realm.

The US tech giant announced the recruitment drive on Sunday, saying it would take place over five years.?Facebook ?said the investment was a "vote of confidence" in Europe's tech industry and its workers.

"As we begin the journey of bringing the metaverse to life, the need for highly specialized engineers is one of Facebook's most pressing priorities," Facebook executives Nick Clegg and Javier Olivan wrote in a statement.

Why Silicon Valley is betting on making this dystopian sci-fi idea a reality

The idea behind the metaverse is to create a space similar to the internet, where users (via digital avatars) can walk around and interact with one another in real time. In theory, users could sit around a virtual meeting table with remote colleagues, and then walk over to a virtual Starbucks to meet up with a friend who lives in another country.

So what will patients think of all this? According to recent research ,?results suggest that the key to implementing automation in healthcare facilities may be to design the interface so that it appeals to expert users who have a high belief in machine abilities

All of this comes with risk. Someone can hack into your medical device or infusion pump and DIY medicine comes with it's own perils. The other problem is that your doctor is not taught how to use all this technology and both you and your doctor are probably data illiterate.

A few short months ago, all this would have been your doctor of the future. Now, it is the doctor of the present, while, admittedly, unevenly distributed. We have quickly gone from high touch to high tech to no touch to no trust.

The outcome of the 4th industrial revolution in medicine is bifurcating in two ways: technology will scale doctors and enable them to talk and touch more, or, it will increasingly disintermediate them resulting in paying them to be low talk low touch supervisors.

Sometimes, touchless medicine is necessar y to address a pandemic.

Of course, one thing that will not change any time soon is your bill for an out of network visit, charges for going to a free standing emergency room, $2M for a single shot of a drug or being charged a level 3 E/M code visit for that "free" Medicare health maintenance visit. It is still rare to get no treatment.

The irony is that pundits are claiming tangible benefits (Tangible?is from Latin tangere, "to touch,") from all these no touch technologies. Touching, isn't it? How should we price a no-touch visit?

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship