High-Tech versus High-Touch

March 8, 2021

According to Wikipedia the terms high-tech and high-touch were coined in 1982 by John Naisbitt in his book Megatrends. Those contrasting terms have been frequently recited around medical circles for decades. Family medicine is either derided or praised by commentators of differing viewpoints as a high-touch medical specialty. Many family doctors embrace this generalization and value being able to see, smell and touch the people who seek their services. But the pandemic has altered that. Almost all of the family doctors who I interviewed expressed concerns about the advancement of “virtual visits” imposed by a coronavirus.

But worries about distancing between a patient and their doctor are not unanimous. Several doctors expressed ongoing concerns, but others have grudgingly embraced the new reality. One doctor who operates a direct primary care practice stated that this option had already been a major part of his practice. Direct primary care practices have divorced themselves from the dominant healthcare payment systems and provide standard primary care services to people and families for a monthly fee. Some services such as prescription refills, telephone consultations, advice and management of many minor illnesses can be accomplished swiftly and safely without requiring an appointment for an in-person visit. Subscribers to direct primary care doctors insist on such amenities. But even direct primary care doctors often want and need to host in-person examinations.

Doctors who worked primarily in-person prior to the pandemic faced a greater challenge. After crash coursing the technology needed to host virtual visits, some doctors admitted the change was “not as awful” as they had anticipated. One experienced family doctor who expected to “hate virtual visits” discovered that her “eyes and ears were more important tools than her hands”. Smaller practices that did not invest heavily in technology for visual contacts realized that they could reasonably meet a number of healthcare needs without literally seeing the patient. Getting paid for such services proved to be another challenge. A few doctors feel an ongoing deep loss of satisfaction when visits are conducted virtually and one doctor admitted he felt a remote visit had, at least once, compromised his ability to make a timely referral to a hospital.

Several years ago I heard a commentary on concerns about technology that encroaches on the traditional doctor-patient relationship. The speaker related an experience when he needed to access some currency late one night while on his way to visit one of his favorite patients in her home. He was able to stop by the, then new-fangled, ATM and get some cash after his bank had closed for the day. He suggested that useful technologies could and should be applied to medical care just as they are in other enterprises. Perhaps the pandemic will help us safely implement some convenient options that will benefit both patients and their doctors.   

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