Continuing Education... Eric Topol on the Power of Patients in a Digital World

EconTalk Extra
by Amy Willis
PRINT
Eric Topol on the Power of Pat... Nicholas Vincent on the Magna ...

There's a healthcare revolution underway, and while your smartphone may be center-stage in this drama, there's more to the story than apps. Eric Topol of the Scripps Translational Science Institute joins EconTalk host Russ Roberts for this week's conversation.

Now we'd like to hear from you. Please respond to any of the following in the Comments. Reach out to your friends, too, and let's all continue the conversation.

The Patient Will See You Now.jpg

1. What are your top three takeaways from this week's episode?

2. How can the sharing economy enhance patient-driven health care? How do the barriers to entry for medical services compare to those for rentals or other services? (For more information on the sharing economy and some of its rising stars, you might want to revisit this episode with Marc Andreessen.)

3. When asked about big data, Topol replies, "It's not big data...it's big data per individual." What does he mean by that, and what insights does this suggest about the perils and promise of big data in health care?

4. Have you encountered paternalism from doctors? How did you handle it?

5. If you are a doctor, what concerns you about growing patient power? Do you think this can go too far? Has it affected your practice of medicine?

6. How will your next medical encounter as a patient be different, if at all, after having listened to this week's conversation?

Comments and Sharing



TWITTER: Follow Russ Roberts @EconTalker


COMMENTS (11 to date)
Saurabh Jha writes:

I recently finished reading Dr. Topol's book. It's fascinating. I have no doubt that many of his predictions will come true - although I would give a time frame of 50-100 years.

Possessing more information may be empowering but will not yield benefits linearly, and often could be more confusing.

This is because information is imperfect. The substrates we have today are imperfect - which is why there is a huge push for precision medicine.

In the healthy person the likelihood that any fragment of information is a false positive (false alarm) exceeds the likelihood that it is a true positive. The same is not true in people who are ill.

I have seen consequences of this anticipatory and preventive medicine. Often we can do more harm than good.


Mark Sundstrom writes:

1:

a) There are far more health-related apps and capabilities for smartphones than I knew about. I had thought it was fairly limited so far.

b) Yet again, after an EconTalk interview, I want to read the book authored by the interviewee. I’ve just started it.

c) What he talks about is important enough that I’ve sent a copy (both the podcast and the book) to a friend currently going to medical school.

4 & 6: after enjoyed the previous podcast with Topol (and read that book, too), I’m well aware of the paternalism, though I haven’t encountered it myself. I’m likely to bring a copy of this book the next time I see the doc.

Brian W writes:

1. The three biggest takeaways for me were that a lot of positive change is being driven by the cell phone, that soon I will have more of a hand in my own health monitoring and that the current medical structure will probably try and stop most of the innovation.
2. I think the sharing economy could potentially enhance patient driven health care by potentially allowing large groups share expensive fixed assets instead of hospitals. Imagine if a company owned an MRI machine and instead of an expensive doctor monitoring it, it was an inexpensive clerk. You could then take the results and upload them to a computer program which did the analysis. I would imagine such a scenario would be cheaper and allow for more efficient use of such assets.
3. I assume the biggest challenge with so much data for each person will be analyzing it in a useful fashion and ordering it in a way in which it is easy to access. Tons of data is not very useful if nobody knows how to mine it properly and productively.
4. I have encountered such issues quite a bit as my wife and I go through her pregnancy . Frankly there is no solution besides having the knowledge from research to counter bad arguement and relying on my sister in law ( doctor herself) to call and argue on our behalf when we disagree about treatment. There have been more then a few occasions I have had to call doctors and hospitals up afterwards and to angrily discuss why they threatened my wife with a waiver and acted like a bully.
5. For a doctor I am sure the biggest concern is people misusing data and using the wrong treatments. I think from a financial standpoint it will affect nurses more then doctors since we will still need the opinions for complex problems but won't need the physical labor for simple things like drawing blood.
6. I think this podcast will encourage me to ask more questions and to try and make the experience more about me as the patient and less about the doctor lecturing me.

Russell W Loomis writes:

I found the episode compelling and hopeful. I love technology (although I am not a total techie, by any measure).

Over the past few years I have grown to dislike the interaction with the GP as the gatekeeper to a test or specialist. Most of my visits are a complete waste of my time, a hoop I am forced to jump through to get the test or see the person I want. I'm hoping the entrenched powers will be over run with the onslaught of new technology. My dream is to have my in house robot handle all my medical needs (I'll request it has a Russ Roberts voice and be well versed in all things Adam smith to entertain me while waiting for my test results).

A side note: I went online and purchased the I- phone cardiogram device described in the episode. Looking forward to playing around with it.

Your show is a real joy for me every week Russ. This one was a real winner. I love the shows that are tech related and/or off the beaten path of what is considered typical economic discussion.

Keep it up Russ. Great job,

The other Russ

Sean Lanoie writes:

1. - always keep my phone charged, it’s becoming the key thing I carry around (superseding my wallet)
- if I’m in charge of my data, I better figure out how I can protect it and my privacy (most people, including me, are not very good at this)
- I wish I had a stronger grounding in what can be measured to see what should be measured about my health.
2. - the sharing economy could allow for a huge increase in the scale for medical trials. The barrier of entry could be lowered to the point of only needing a small attachment to a smartphone to log the sought for data.
3. - it’s a huge expansion of the data set available to a doctor. If the patient can personally track so many things, that data can be immediately available across a longer period of time than the short subset of time that a doctor can order a test for.
6. I will be much more mindful that the amount of time my doctor sees me is almost zero (I go very little) and that what he sees of me is only a snapshot. My doctor doesn’t and can’t have a full picture of what my health is when I get to the office. He has to discover it almost from scratch.

Tom Coss writes:

What medicine misses with regard to technology is the notion of emergence. Healthcare will soon begin it's 50th year of top down management (Medicare turns 50 this August), but good medicine is emergent.

If Dr. Topol is right, which I believe him to be, and the patient will be in control, we need emergent processes to support that control which I've done. So will medicine adopt such a radical notion? Will physicians accept technologies providing patients the control they desire? Are we willing to allow free-market technology to help?

I'll let you know.

Krishna Roskin writes:

I was pretty disappointed in how this topic was covered. I had been looking forward to it all week. There is a lot of promise in this area but also a lot of questions, and not easy questions, that will have to be addressed. Russ barely skims the surface of the issues at play here. There are a lot of companies in this field making questionable and unsubstantiated claims and Russ's usual skepticism, the main reason I listen to this podcast, was conspicuously absent.

The story about Russ's daughter fainting and the paramedics not leaving without a signed waiver isn't a story about medical paternalism in the slightest and everyone listening understood that, it's guaranteed that Topol knew it.

Tom Coss writes:

Krishna, I'm curious about your initial expectations. Medicine is certainly complex, but that's not to say that it exists outside common principles in economics. All parties inside healthcare respond to incentives and hold biases, all regularly explored here on Econtalk.

As an RN, I often deal with patients facing clinical challenges and when I ask them for specific clinical data, they tell me their Dr. said it was "normal" or that they're "not worried". What's up with that? Shouldn't you know your own numbers and what they mean? After all, just who is going to do your healing for you?

Since the Hippocratic Oath of 460 BC, medicine has been about holding on to information, consider this little gem: "I will pass on all precepts and lectures and all other learning to my sons, those of my teachers and to those pupils duly apprenticed and sworn, but to none others." Does that sound democratic to you?

Prior to Penicillin, one could diagnose but not treat. We're on the cusp of a similar revolution in scope and impact.


Stilicho writes:

As a Family doctor this podcast was hard to listen to. I will try to keep the biblical admonition in mind. "A rebuke is sweet to the wise." In my experience patient empowerment has not been an unmitigated good, and is usually expressed as non compliance with a prescribed treatment. Furthermore, the prescription information provided by the pharmacist has more often led to a patient's not taking the medication and a trip to the hospital, than the recognition of a side effect and appropriate stopping of a medication.

I understand the average physician will allow a patient to speak about 20 seconds before interrupting them and directing the history phase of the medical visit. I try to wait 60 seconds before interrupting. I don't always make it.

I have enjoyed the patients who have the NIH description of their illness from a website and I find them to be motivated and intelligent. They are not always wrong. If they desire referral to a specialist they still have to have my evaluation. I do not like to make needless or improper referrals and proper care requires the proper evaluation and referral process. Also, the wait to see the specialist may be quite long, and if you are on Medicaid they may not see you at all.

The study of disease, pathology, is only part of the equation in medicine. One must understand the patient and consider how the disease will present in a patient. Since people have diseases, the relationships with doctors is different depending on the specialty, condition of the patient, seriousness of the illness, their place within the family, and the personalities of all involved. I think technology will eventually affect the doctor patient relationship. I do not think the cell phone will replace the physician for a long while.

Tomorrow, I will work at the Free Medical Clinic in my hometown. I volunteer once a month. All these patients, who have no insurance and are not covered by government programs, have cell phones. It would be great to have an app that recorded blood glucose in diabetes. We could review these at a visit. Only the rare patient is currently bringing a glucose log. Perhaps the pace of technological change will transform my practice in other ways I can not now imagine. Until then I will slog on and try to listen to patients for 1 minute before interrupting. After all, they are trying to tell me what is wrong with them.

Linus Kan writes:

1. What are your top three takeaways from this week's episode?

- Smart phones are disrupting health and medicine.
- Doctors, hospitals and administrators/ government are paternalistic. (I would be too, if being paternalistic made me rich.)
- We do not challenge doctors enough. Following medical advice is a contemporary dogma.

2. How can the sharing economy enhance patient-driven health care? How do the barriers to entry for medical services compare to those for rentals or other services?

Will be perfect if sharing economy in health grows so that I can 'recruit' a understudy doctor to help me understand my health care needs and ask my doctor the questions about my illness, diagnoses reports and treatment approaches.

3. When asked about big data, Topol replies, "It's not big data...it's big data per individual." What does he mean by that, and what insights does this suggest about the perils and promise of big data in health care?

Big data is often lateral across population at a particular point in time. Topol is talking about sequential for a particular individual. This does not qualify as 'big data' but (for me) is the most interesting takeaway of this talk - that the peculiar/ particular trends in YOUR individual case are extremely relevant and significantly important for your line of treatment.

4. Have you encountered paternalism from doctors? How did you handle it?

Almost every visit to a doctor has an unspoken component of 'I know better about this than you.' And that may be true. But what is simultaneously true is that you (the doctor) SHALL not make any decision for me. That power is mine and cannot be compromised.

5. If you are a doctor, what concerns you about growing patient power? Do you think this can go too far? Has it affected your practice of medicine?

I am not a doctor but if I were one, I would be very concerned with growing patient power combined with growing outcome based payments I will receive (in the future). I fear that I am seeing the caboose of the gravy train.

6. How will your next medical encounter as a patient be different, if at all, after having listened to this week's conversation?

A greater sense of responsibility for my condition, health, treatment and outcomes.

Marc Hebert writes:

I found Eric Topel's talk so fascinating that I immediately downloaded his book to my Kindle. It really opened my eyes, and made me start searching for Android apps!

In particular, the passage on Theranos caught my attention, because I have a friend who worked on the design of the portable testing machine for a time. It strikes me that the Theranos approach will likely be very quickly disintermediated, almost before it reaches critical mass, by more direct, faster, cheaper methods.

So, imagine my delight when I encountered this blurb tonight in Ray Kurzweil's daily newsletter:

http://www.kurzweilai.net/a-chip-implanted-under-the-skin-allows-for-precise-real-time-medical-monitoring?utm_source=KurzweilAI+Daily+Newsletter&utm_campaign=01beaa1cea-UA-946742-1&utm_medium=email&utm_term=0_6de721fb33-01beaa1cea-281890285

Comments for this podcast episode have been closed
Return to top