"It is only with the heart that one can see rightly; what is essential is invisible to the eye."
Antoine de Saint-Exupery
As a small business trying to take on the medical system, we certainly gravitate towards things that help us be more productive. When we find a more efficient way to do something, we usually seize it.
The medical system seems to have the same impulse. If three minutes can get stripped off a visit, those three minutes get eliminated. If a step can be removed from a process, administrators are thrilled to advocate that providers do so.
Sometimes, these "efficiencies" in medicine lead to significant losses and unintended consequences.
For example, one thing we've noticed being eliminated from medicine -- because it's not efficient -- is everyday collaboration, information sharing, and human interaction. A highlight of my schedule as a surgeon has always been sitting in the doctors' lounge in the spare 10 minutes before an operation. I'd chat with other doctors who also had a free minute about new medical findings, our kids' sports, a shared patient, or a treatment conundrum. Those simple interactions would be satisfying in all kinds of ways, but with very few tangible, "efficient" outcomes. Over the course of a week, though, I always gained powerful insights, identified care opportunities, and collaborated in ways that saved time and improved quality of care.
Recently, we came across a couple of articles that show how the efficient, streamlined approach can actually strip out huge positives in other contexts. For instance:
- Everything from asthma to obesity is affected by the microbial balance in our gut. As this informal article describes, some research is now showing that it is integrated, indirect consequences or combinations of healthy habits that seem to improve our intestines' microbial makeup and protect us from disease. For instance, the negative effects of a McDonald's breakfast on inflammation can be nullified by drinking a glass of orange juice with the meal. Researchers haven't yet been able to strip out the "active" component of the orange juice in the dynamic system and are concluding that it is actually the combination of things like flavinoids, antioxidants, vitamins and soluble fiber that create the effect.
- It turns out that "Ground-up artemisia plants, from which the anti-malaria drug artemisinin is derived, appear to work much better than the refined drug does by itself, according to research at the University of Massachusetts," reports the New York Times. Why? The plant goes beyond just the active ingredient that we extract to create the anti-malaria drug. Much like with the orange juice (or the doctors' lounge), it is a combination of multiple factors that create the positive effects -- and a shortcut won't get you all the way there.
That's why, when we are asked for advice on telemedicine and medical collaboration, we always suggest using common sense and not necessarily doing the most efficient, stripped down, basic thing. For instance, secure text messaging services can be effective in some situations, but often lose the richness of real interactions. Sometimes, a face to face conversation is still the best way to determine a course of treatment. And when that's not possible, we believe that a telemedicine solution that incorporates informal discussion, video, photos, and perspectives from multiple providers (like iClickCare) is the way to go.
In the same way that the plants are more effective than the malaria drug itself, we advocate for "leaving in" some of the still-inexplicable positives that come from doing the traditional thing that works. Have the conversation, even if it's not 100% obvious what came of it. Use the richer store-and-forward solution. Do what works, even if we don't yet understand all the reasons why it works so well.