December 17, 2024 • 21 mins
Digital diagnosis explores how telehealth is changing the physician patient relationship. Through interviews with both physicians and patients we uncover where telehealth shines and where it falls short, ultimately getting to the heart of what medicine is and how we can use technology in a way that puts people first.
Interviewees:Sarah Grace LeBaronLyle Joyce, M.D.Randi ZellerResearch:● https://www.nature.com/articles/s41746-024-01152-2● https://pmc.ncbi.nlm.nih.gov/articles/PMC10210114/● https://pmc.ncbi.nlm.nih.gov/articles/PMC7690251/Music:● Phase Purple by <a href="https://app.sessions.blue/browse/track/290642">Blue Dot Sessions</a>● Brek PKL by <a href="https://app.sessions.blue/browse/track/290643">Blue Dot Sessions</a>● Our Fingers Cold by <a href="https://app.sessions.blue/browse/track/290644">Blue DotSessions</a>● The Griffiths by <a href="https://app.sessions.blue/browse/track/290645">Blue Dot Sessions</a>
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
When I was younger, my fatherwould tell me he was a detective.
I grew up in his world.
My father taught me how toput on a stethoscope before I
could even pronounce the word.
I remember exploring the hospital withhim, the escalators with the changing
light murle, the holloways with thegleaming wooden walls, and trying on
my father's white coat and thinkinghe was the coolest person ever.
(00:27):
My father says he decided to becomea physician at five years old, but I
was not initially drawn to medicine.
I first became enthralled by computerscience, fascinated by the ability
to use different permutations of 26letters to code up and solve the world's
next currently unsolvable problem.
Yet, as my computer science coursework gotharder, my coding assignments got longer.
(00:52):
I began feeling dissatisfied at thethought of spending my entire day in front
of a computer, confused and concernedabout the sudden Midco life crisis.
I started consideringother career options.
I began shadowing a bonemarrow transplant physician.
Something that stood to me washalf of our clinical visits were
actually done via telehealth.
(01:14):
I personally had never used it, so Ihad not realized how common it was.
There was one visit in particularthat I'll never forget.
A young couple opened the call, sittingclose to each other in the frame, smiling.
The physician I was shadowing, greetedthem and began making small talk.
I came to understand that thiswas a six month check-in postpone
(01:36):
marrow treatment for the husbandwho had been battling cancer.
Suddenly the physician audibly gasped.
She had just opened the husband'simaging and discovered the
devastating news that his cancerhad returned, shaken up herself.
The physician told them the diagnosis.
(01:57):
The wife began crying, andwe sat there, me, the family,
and the physician in silence.
I felt useless.
Instead of being there to comfortthem, it felt like we were intruders
into a painful and personal moment.
(02:20):
If we had been in person, perhaps wecould have offered a tissue or comforting
hand, but even if we wanted to, whatcould we have done divided by the screen?
That moment stayed with me.
Telehealth offeredconvenience, but felt cold.
It wasn't just telehealth AI models,smart watches, and other tech
(02:43):
seemed to be erasing the need forphysical doctors and appointments.
I began to wonder, is thisthe future of medicine?
Should we be concerned?
The very first physicianswere sourcers or witches.
(03:08):
Magic and religion played a largepart in understanding the treatment
of diseases in early human society.
If your child fell ill, it was becauseyou had wronged the gods in some way.
Physicians often treated the whole person.
The whole soul and bodyhealing was a holistic ritual.
(03:28):
These practices couldn't produceany physical effects, and in fact,
lacking any scientific backing.
Sometimes they made illnesses worse.
But when people believed in them, itcould still make them feel a sense
of calm and peace, just knowingthat someone had taken care of them.
(03:49):
Over time, medicine slowly beganshifting from magic to method.
Ancient civilizations began documentingobservations, experimenting with herbs,
and creating systems like Ayurvedaand traditional Chinese medicine
that people still follow today.
Hippocrates introduced the ideathat diseases had natural causes,
(04:10):
not just divine punishment.
The Renaissance and the Enlightenmentbrought advances in anatomy and the
scientific method, giving medicinea firm foundation in evidence.
By the 19th century germ theory andvaccines transformed how we treat
diseases, and in the 20th century.
We ushered in antibiotics,organ transplants, and the first
(04:34):
glimpse of genetic medicine.
And now here we are in the 21st centurywhere medicine has taken yet another
transformative leap in the digital age.
Telemedicine is now revolutionizinghow we connect with healthcare.
Medicine has always been about meetingpeople where they are, and today that
(04:58):
means leveraging technology to bring care.
Directly into our homes, but how istelemedicine changing the patient
physician relationship and what challengesand opportunities does it bring?
Telemedicine is often praised for itsability to bridge the gap in healthcare
(05:18):
access, especially for real patientsand those managing chronic conditions.
But how does it actually feel forsomeone who relies on it for their care?
To learn more, I spoke with Sarah,a 19-year-old sophomore at Stanford
University, who has lived with typeone diabetes since she was nine.
Growing up in a small rural town,Sarah witnessed firsthand the
(05:38):
challenges of accessing healthcare.
I know people out in ruralnowhere who literally have not
had an annual in like 15 years.
While telehealth has the potentialto revolutionize real healthcare.
Many patients stillaren't engaging with it.
If you do have like a pressing issueso bad that healthcare is necessary,
you were already going in person.
Sarah, however, has had plentyof experience with telehealth.
(06:01):
Her insurance requires her to attend fourdiabetes related appointments a year.
I would have to go to San Francisco,a three hour drive, not counting
traffic four times a year.
Telehealth became a thing, and thenit became two times a year on paper.
Sarah seems like the perfecttelehealth success story, young tech
(06:22):
savvy, and managing a condition thatbenefits from frequent monitoring.
I kind of hate telehealth to be honest.
From a practicality perspective.
Telehealth was incredible, butit's not like anything ever got
done in-person appointments were,these were big boy appointments.
The telehealth visits were quick,usually just five to 10 minutes.
And lacked the depth of in-person care.
(06:42):
She felt like the virtual appointmentswere separate from the real ones.
Another issue Sarah faced was privacy.
I don't feel as comfortablecommunicating through telehealth, and
it might be because when I'm talkingthrough telehealth, I'm talking
in my living room or even in mybedroom where my parents can hear me.
On the other end, there's stillinformation that I feel private about
and I just feel much more comfortablerelaying it in the privacy of the
(07:05):
medical room with thick walls.
For patients like Sarah,telehealth is a double-edged sword.
Practical, but imperfect bridginggaps, and yet creating new challenges.
Sarah's experiences are just oneperspective, and just like patients
often seek second opinions fromdifferent physicians, I want to
hear from others to see how theirtelehealth experiences compared.
(07:27):
Anything that I could do by video that'smedically related, I would prefer to do.
That's Randy Zeller.
She's 60 years old andlives in New York City.
She has had a number of experienceswith Telehealth, including for all
of her care during the pandemic forInsomnia and with a long-term therapist.
And even before that, she wasan expert in video calling.
(07:49):
I've been doing, uh, video meetingssince, I don't know, early 2000,
2005, 2006, something like that.
As a former consultant for two law firms,Randy is no stranger to busy schedules.
For her telehealth is a no-brainer.
I put a pretty high premium onnot wasting time in my life and
(08:12):
doing things I wanna be doing.
She loves the efficiency of telehealthappointments and sees it as an
essential to keeping up with herfast paced lifestyle in the city.
Sometimes they're 10 minutes.
How's this medicine working?
Good, bad.
All right.
Maybe we change it to this.
Great.
Okay.
I'll talk to you in three months.
It's much more efficient andeffective than having to go
in when there's no real need.
(08:34):
But as convenient as virtual visitsare, they come with a downside.
I'm talking to you.
I need you to sit andnot do anything else.
Look, I'm guilty of the same thing.
I like being off screen sometimes sothat I can multitask on a call where
I don't wanna pay full attention.
Sure, it's easy to multitaskduring a telehealth appointment.
Maybe check a message or reorganizemy calendar while the doctor
(08:54):
talks, but that's the problem.
Telehealth sometimes feels morelike a background podcast than a
focused one-on-one interaction.
Let's be honest, you are probablylistening to this podcast while
doing something else too, right?
Is that the way we want to treatour health convenience over quality.
(09:15):
When I'm in the same room withsomeone, there's an unspoken
obligation to focus face to faceconversations demand attention.
In a way that no screen, no matter howgood the camera quality is, can replicate.
(09:35):
There's no question about what technologyhas made a tremendous improvement in
our ability to take care of patients.
That's Dr.
Lyle Joyce, a cardiothoracic surgeon Withover 40 years of experience at renowned
institutions like the Mayo Clinic.
Minneapolis Heart Institute and theUniversities of Minnesota and Utah.
Over the course of his career, Dr.
(09:56):
Joyce has witnessed firsthand howtechnology has transformed medicine.
Perhaps Covid was what taught ushere in the US that it's possible to
take care of patients without seeingthem face to face in all situations.
We were forced to see patientsvirtually, and I think we all
now feel more comfortable.
(10:18):
Both patients and physiciansalike were made to quickly
adapt to online healthcare.
While Dr.
Joyce cannot perform surgeries onZoom, he does offer patients the
option to have their pre-surgeryconsultation online or in person.
Many times, we will have multiplefamily members in attendance during
their telemedicine visit thatwe probably wouldn't have had.
(10:41):
Had the patient had to make the trip tothe clinic or to the hospital for families
spread across cities or even countries.
Telehealth can be a lifeline.
It allows loved ones to be apart of a patient's journey,
offering emotional support andstaying involved in their care.
Even with these advantages,telemedicine has limitations many times.
(11:04):
The labs and the x-rays and allthe data that we can collect, which
suggests that a patient would have anacceptable risk of going through surgery.
And yet when we finally see thatpatient at the time, we're going to
take the patient to the operating room.
We realize that this patient is.
Uh, not as healthy as the, thefigures on the paper would suggest.
(11:26):
They call it the bedsideappeal or curb appeal.
It's a gut feeling that an experiencedsurgeon will have laying eyes on
the patient rather than seeing'em through a virtual visit.
Maybe it was a lack of thatbedside or curb appeal.
That made Sarah feel like her telehealthvisits weren't being taken serious.
But Sarah thinks it's technology itselfthat is to blame, and I don't think
(11:48):
it was any of my doctor's faults.
They're great doctors.
I think there's just something inherentlyabout communicating through a screen
versus communicating in person wheresomething gets lost in translation.
This raises an important question.
Why is there this gapbetween data and diagnoses?
Is it a technical problemthat faster internet speeds or
ultra HD cameras could solve?
(12:10):
Or is this dissonance somethingdeeper that no amount of
technological advancement canever fully bridge technology.
It's been a part of modernmedicine for decades.
Appointments begin with measurementsof height, weight, and vitals.
Doctors order x-rays or MRIs in hospitals,machines track your heart rate and
(12:32):
blood pressure in real time feedingconstant updates to the nurses station.
But there's something, datacan't capture something.
Deeply human.
A doctor can walk in the roomand say, Hey, you look more
tired than you did yesterday.
Is everything okay?
There are many words to tryto describe this feeling.
(12:52):
Some call it your spiritor your aura or your vibes.
In the digital space,there is no aura or spirit.
You are simply a combinationof red, green, and blue filters
behind the pixels on your screen.
Who's to say if you're looking moretired than usual, or that's just the
camera quality, distorting the video.
(13:16):
As both physicians and patients, we areconstantly surrounded by devices, not
just in the hospital, but at our home too.
Headphones, smart watches,phones, they are everywhere.
And one of the most commonly usedsuch devices is a continuous glucose
monitor used by diabetic patients.
Oh my Dexcom.
It's really a miracle device.
(13:37):
While we spoke, Sarah lifted up herright arm to show me the insulin monitor.
She also has a continuous insulin pumpon her hip, and they both connect to the
app and provide continuous readouts ofexactly what her blood sugar levels are
and how much insulin she is receiving.
The data feed is constant.
One of our alarms rangduring our interview.
I was struck by how casuallySarah dismissed the alarm.
(13:59):
As we continued talking, it becameclear that her life is overwhelmed
with these alerts, so much sothat they become background noise.
She played another alarm for memoments later, three or four times
a night every night for the last10 years, and has woken me up
the data from the Glucose monitorupdates every five minutes.
(14:21):
If someone gets eight hours ofsleep, that's 96 times every single
night, but the alternative is fatal.
I think one in 20 type one diabeticsdies from dead in bed syndrome
where their blood sugar goes reallylow in the middle of the night.
And they don't wake up even sosome diabetics are willing to take
the risk for a good night's sleep.
(14:42):
There are certain types of Type onediabetics who will go off of it.
They'll say, I'm too overwhelmed.
It's too bad for my mental health.
I asked Sarah if she thought the appcould be improved with user feedback.
No, the app, I think the app'sas good as it could ever be.
I think it's just hell to befed so much data and yet without
(15:03):
data, there is no medicine.
During the pandemic, Sarahstarted noticing her hair was
falling out more than usual.
In the midst of stay at homeorders, the only appointments
she could get were online.
But these appointments did not leadher closer to a diagnosis instead.
Her concerns were dismissed.
They defaulted to, oh, well,she's just being a little crazy.
(15:24):
She's being a woman.
You know, Sarah had already cometo expect her concerns would not
be understood through telehealthappointments, but there was one major
difference between getting care onlinefor her diabetes and for her hair loss.
The availability of data, and it's twoentirely opposite ends of the spectrum of
medical dehumanization because on the onthe T 1D end, everything is quantifiable,
(15:46):
everything is data, especially online.
When you're not interacting withme, my life gets reduced to the
numbers you see on this graph.
But for her hair loss, there was no data.
It was just her word.
Without me asking.
Sarah pulled back her hair and showedme the spot where her hair loss had
been the worst, as if she still felt sheneeded to prove to me that it was real.
(16:06):
I skipped my senior prom becauseI felt so insecure about it.
After she came to college, one ofthe first things she did was book an
in-person appointment for her hair loss.
It took her less than five minutes to lookat my scalp and go, yep, that's alopecia.
More likely than not, we have allbeen or will be patient someday.
(16:27):
Doctors intimately impact all of us.
They've been defining characters ofmy life because they've been there to
resolve or sometimes to worsen some ofthe most pressing issues of my life.
Your medical journey and care isextremely personal and sensitive.
When a physician performs a physical examor an operation, you are in a completely
(16:50):
vulnerable state that is the contractbetween the physician and the patient.
They will see you throughvulnerability with dignity.
That we're losing a ritual.
We're losing a ritual that I believeis transformative, transcendent,
and is at the heart of thepatient physician relationship.
Dr.
Abraham JE is a physician and author.
(17:13):
Ted in 2011 gave a TED talk to themost important innovation, I think in
medicine to come in the next 10 years,and that is the power of the human hand.
To touch, to comfort, to diagnose,and to bring about treatment.
And it's true.
Humans, hands built computersfrom scratch, wrote lines of
(17:33):
code that took humans to themoon, built AI like Chatt, PT.
That honestly seems like somethingstraight out of a sci-fi movie.
That's what excited me abouttechnology is how relentlessly you
can pursue and innovate with it.
Yet, in thinking about medicine only froma technical standpoint, I realized I was
missing a crucial component of medicine.
The people, technology is meant tobe explored and used fully, but it
(17:59):
is up to physicians to ensure thatwithin this technology, the human core
of medicine does not get sidelined.
I asked Dr.
Joyce what this might looklike to use technology without
losing that human connection.
First of all, one has to bepatient and to have a good ear.
Always listen to your patient, give themthe time they're need, and then just
(18:24):
truly show your love and concern for them.
There's a conflict in medicinecalled bedside manner.
It includes the tone of voice, bodylanguage, empathy, and active listening.
That helps build trust and comfortbetween patients and their caregivers.
Good bedside manner makes patientsfeel heard, valued, and supported.
(18:45):
But what about a digital bedside manner?
I have always loved innovationand technology, and there was
a time I thought that I wouldspend my life working with them.
Now I plan to follow in my father'sfootsteps and become a physician.
Still coming from a computer sciencebackground, I initially thought
technology was the key to the futureof medicine, but ultimately the reason
(19:10):
I've chosen to pursue medicine, I.
Is because I wanted to do somethingwhere I felt connected to people.
I think about my future patients a lot.
I wonder what I can do tobecome a better physician.
I found that the answer is not to beknowledgeable on and use the latest or
(19:31):
most complex technologies, but to listen.
If I could get my hairdone by video, I would.
I don't do telehealth anymore'cause that's how little I respect.
I think both as physicians and aspatients, we should proceed with caution.
There will be people like Randywho find digital connection and
technology perfectly fitting into theirlives and meeting all their needs.
(19:53):
But that doesn't mean we don't listen topatients like Sarah, who feel sidelined
and forgotten by digital health andyearned for a more meaningful connection.
As we continue leveragingtechnology, we must think.
Even more deeply about how to infusehuman connection, compassion, and
care through these new mediums.
It's a powerful lesson.
(20:14):
Pixels can't capture the full picture.
As a child, I associated the hospitalwith the warmth, love, and the excitement,
and being in the presence of my father, Ialways knew that there was someone there
that was on my side and cared about me.
Every patient deserves tofeel that way to know that.
(20:35):
Physically, digitally andemotionally, there is someone on
their side taking care of them.
So only time will tell how thesetechnologies and this modern influence of
diagnosing treatment in the digital spacewill affect both patients and physicians
and change the future of medicine.
(20:57):
The only truth is that thestory of healthcare is one that
will always be written in the.
Complex language of human interaction.
You've been listening to DigitalDiagnosis, which is produced by Priyanka
Rera as part of a Braden grant withthe Stanford Storytelling Project.
Music from Luda, blue Sessions,and sound Effects from free sound.
(21:17):
Many thanks to Sarah, Randy and Dr.
Joyce.
And Laura Joyce Davis Geral, DawnFrazier, and everyone else at the Stanford
Storytelling Project and in the BradenGrant for feedback and inspiration.
When I was younger, my fatherwould tell me he was a detective.
I grew up in his world.
My father taught me how toput on a stethoscope before I
could even pronounce the word.
I remember exploring the hospital withhim, the escalators with the changing
light murle, the holloways with thegleaming wooden walls, and trying on
my father's white coat and thinkinghe was the coolest person ever.
(00:27):
My father says he decided to becomea physician at five years old, but I
was not initially drawn to medicine.
I first became enthralled by computerscience, fascinated by the ability
to use different permutations of 26letters to code up and solve the world's
next currently unsolvable problem.
Yet, as my computer science coursework gotharder, my coding assignments got longer.
(00:52):
I began feeling dissatisfied at thethought of spending my entire day in front
of a computer, confused and concernedabout the sudden Midco life crisis.
I started consideringother career options.
I began shadowing a bonemarrow transplant physician.
Something that stood to me washalf of our clinical visits were
actually done via telehealth.
(01:14):
I personally had never used it, so Ihad not realized how common it was.
There was one visit in particularthat I'll never forget.
A young couple opened the call, sittingclose to each other in the frame, smiling.
The physician I was shadowing, greetedthem and began making small talk.
I came to understand that thiswas a six month check-in postpone
(01:36):
marrow treatment for the husbandwho had been battling cancer.
Suddenly the physician audibly gasped.
She had just opened the husband'simaging and discovered the
devastating news that his cancerhad returned, shaken up herself.
The physician told them the diagnosis.
(01:57):
The wife began crying, andwe sat there, me, the family,
and the physician in silence.
I felt useless.
Instead of being there to comfortthem, it felt like we were intruders
into a painful and personal moment.
(02:20):
If we had been in person, perhaps wecould have offered a tissue or comforting
hand, but even if we wanted to, whatcould we have done divided by the screen?
That moment stayed with me.
Telehealth offeredconvenience, but felt cold.
It wasn't just telehealth AI models,smart watches, and other tech
(02:43):
seemed to be erasing the need forphysical doctors and appointments.
I began to wonder, is thisthe future of medicine?
Should we be concerned?
The very first physicianswere sourcers or witches.
(03:08):
Magic and religion played a largepart in understanding the treatment
of diseases in early human society.
If your child fell ill, it was becauseyou had wronged the gods in some way.
Physicians often treated the whole person.
The whole soul and bodyhealing was a holistic ritual.
(03:28):
These practices couldn't produceany physical effects, and in fact,
lacking any scientific backing.
Sometimes they made illnesses worse.
But when people believed in them, itcould still make them feel a sense
of calm and peace, just knowingthat someone had taken care of them.
(03:49):
Over time, medicine slowly beganshifting from magic to method.
Ancient civilizations began documentingobservations, experimenting with herbs,
and creating systems like Ayurvedaand traditional Chinese medicine
that people still follow today.
Hippocrates introduced the ideathat diseases had natural causes,
(04:10):
not just divine punishment.
The Renaissance and the Enlightenmentbrought advances in anatomy and the
scientific method, giving medicinea firm foundation in evidence.
By the 19th century germ theory andvaccines transformed how we treat
diseases, and in the 20th century.
We ushered in antibiotics,organ transplants, and the first
(04:34):
glimpse of genetic medicine.
And now here we are in the 21st centurywhere medicine has taken yet another
transformative leap in the digital age.
Telemedicine is now revolutionizinghow we connect with healthcare.
Medicine has always been about meetingpeople where they are, and today that
(04:58):
means leveraging technology to bring care.
Directly into our homes, but how istelemedicine changing the patient
physician relationship and what challengesand opportunities does it bring?
Telemedicine is often praised for itsability to bridge the gap in healthcare
(05:18):
access, especially for real patientsand those managing chronic conditions.
But how does it actually feel forsomeone who relies on it for their care?
To learn more, I spoke with Sarah,a 19-year-old sophomore at Stanford
University, who has lived with typeone diabetes since she was nine.
Growing up in a small rural town,Sarah witnessed firsthand the
(05:38):
challenges of accessing healthcare.
I know people out in ruralnowhere who literally have not
had an annual in like 15 years.
While telehealth has the potentialto revolutionize real healthcare.
Many patients stillaren't engaging with it.
If you do have like a pressing issueso bad that healthcare is necessary,
you were already going in person.
Sarah, however, has had plentyof experience with telehealth.
(06:01):
Her insurance requires her to attend fourdiabetes related appointments a year.
I would have to go to San Francisco,a three hour drive, not counting
traffic four times a year.
Telehealth became a thing, and thenit became two times a year on paper.
Sarah seems like the perfecttelehealth success story, young tech
(06:22):
savvy, and managing a condition thatbenefits from frequent monitoring.
I kind of hate telehealth to be honest.
From a practicality perspective.
Telehealth was incredible, butit's not like anything ever got
done in-person appointments were,these were big boy appointments.
The telehealth visits were quick,usually just five to 10 minutes.
And lacked the depth of in-person care.
(06:42):
She felt like the virtual appointmentswere separate from the real ones.
Another issue Sarah faced was privacy.
I don't feel as comfortablecommunicating through telehealth, and
it might be because when I'm talkingthrough telehealth, I'm talking
in my living room or even in mybedroom where my parents can hear me.
On the other end, there's stillinformation that I feel private about
and I just feel much more comfortablerelaying it in the privacy of the
(07:05):
medical room with thick walls.
For patients like Sarah,telehealth is a double-edged sword.
Practical, but imperfect bridginggaps, and yet creating new challenges.
Sarah's experiences are just oneperspective, and just like patients
often seek second opinions fromdifferent physicians, I want to
hear from others to see how theirtelehealth experiences compared.
(07:27):
Anything that I could do by video that'smedically related, I would prefer to do.
That's Randy Zeller.
She's 60 years old andlives in New York City.
She has had a number of experienceswith Telehealth, including for all
of her care during the pandemic forInsomnia and with a long-term therapist.
And even before that, she wasan expert in video calling.
(07:49):
I've been doing, uh, video meetingssince, I don't know, early 2000,
2005, 2006, something like that.
As a former consultant for two law firms,Randy is no stranger to busy schedules.
For her telehealth is a no-brainer.
I put a pretty high premium onnot wasting time in my life and
(08:12):
doing things I wanna be doing.
She loves the efficiency of telehealthappointments and sees it as an
essential to keeping up with herfast paced lifestyle in the city.
Sometimes they're 10 minutes.
How's this medicine working?
Good, bad.
All right.
Maybe we change it to this.
Great.
Okay.
I'll talk to you in three months.
It's much more efficient andeffective than having to go
in when there's no real need.
(08:34):
But as convenient as virtual visitsare, they come with a downside.
I'm talking to you.
I need you to sit andnot do anything else.
Look, I'm guilty of the same thing.
I like being off screen sometimes sothat I can multitask on a call where
I don't wanna pay full attention.
Sure, it's easy to multitaskduring a telehealth appointment.
Maybe check a message or reorganizemy calendar while the doctor
(08:54):
talks, but that's the problem.
Telehealth sometimes feels morelike a background podcast than a
focused one-on-one interaction.
Let's be honest, you are probablylistening to this podcast while
doing something else too, right?
Is that the way we want to treatour health convenience over quality.
(09:15):
When I'm in the same room withsomeone, there's an unspoken
obligation to focus face to faceconversations demand attention.
In a way that no screen, no matter howgood the camera quality is, can replicate.
(09:35):
There's no question about what technologyhas made a tremendous improvement in
our ability to take care of patients.
That's Dr.
Lyle Joyce, a cardiothoracic surgeon Withover 40 years of experience at renowned
institutions like the Mayo Clinic.
Minneapolis Heart Institute and theUniversities of Minnesota and Utah.
Over the course of his career, Dr.
(09:56):
Joyce has witnessed firsthand howtechnology has transformed medicine.
Perhaps Covid was what taught ushere in the US that it's possible to
take care of patients without seeingthem face to face in all situations.
We were forced to see patientsvirtually, and I think we all
now feel more comfortable.
(10:18):
Both patients and physiciansalike were made to quickly
adapt to online healthcare.
While Dr.
Joyce cannot perform surgeries onZoom, he does offer patients the
option to have their pre-surgeryconsultation online or in person.
Many times, we will have multiplefamily members in attendance during
their telemedicine visit thatwe probably wouldn't have had.
(10:41):
Had the patient had to make the trip tothe clinic or to the hospital for families
spread across cities or even countries.
Telehealth can be a lifeline.
It allows loved ones to be apart of a patient's journey,
offering emotional support andstaying involved in their care.
Even with these advantages,telemedicine has limitations many times.
(11:04):
The labs and the x-rays and allthe data that we can collect, which
suggests that a patient would have anacceptable risk of going through surgery.
And yet when we finally see thatpatient at the time, we're going to
take the patient to the operating room.
We realize that this patient is.
Uh, not as healthy as the, thefigures on the paper would suggest.
(11:26):
They call it the bedsideappeal or curb appeal.
It's a gut feeling that an experiencedsurgeon will have laying eyes on
the patient rather than seeing'em through a virtual visit.
Maybe it was a lack of thatbedside or curb appeal.
That made Sarah feel like her telehealthvisits weren't being taken serious.
But Sarah thinks it's technology itselfthat is to blame, and I don't think
(11:48):
it was any of my doctor's faults.
They're great doctors.
I think there's just something inherentlyabout communicating through a screen
versus communicating in person wheresomething gets lost in translation.
This raises an important question.
Why is there this gapbetween data and diagnoses?
Is it a technical problemthat faster internet speeds or
ultra HD cameras could solve?
(12:10):
Or is this dissonance somethingdeeper that no amount of
technological advancement canever fully bridge technology.
It's been a part of modernmedicine for decades.
Appointments begin with measurementsof height, weight, and vitals.
Doctors order x-rays or MRIs in hospitals,machines track your heart rate and
(12:32):
blood pressure in real time feedingconstant updates to the nurses station.
But there's something, datacan't capture something.
Deeply human.
A doctor can walk in the roomand say, Hey, you look more
tired than you did yesterday.
Is everything okay?
There are many words to tryto describe this feeling.
(12:52):
Some call it your spiritor your aura or your vibes.
In the digital space,there is no aura or spirit.
You are simply a combinationof red, green, and blue filters
behind the pixels on your screen.
Who's to say if you're looking moretired than usual, or that's just the
camera quality, distorting the video.
(13:16):
As both physicians and patients, we areconstantly surrounded by devices, not
just in the hospital, but at our home too.
Headphones, smart watches,phones, they are everywhere.
And one of the most commonly usedsuch devices is a continuous glucose
monitor used by diabetic patients.
Oh my Dexcom.
It's really a miracle device.
(13:37):
While we spoke, Sarah lifted up herright arm to show me the insulin monitor.
She also has a continuous insulin pumpon her hip, and they both connect to the
app and provide continuous readouts ofexactly what her blood sugar levels are
and how much insulin she is receiving.
The data feed is constant.
One of our alarms rangduring our interview.
I was struck by how casuallySarah dismissed the alarm.
(13:59):
As we continued talking, it becameclear that her life is overwhelmed
with these alerts, so much sothat they become background noise.
She played another alarm for memoments later, three or four times
a night every night for the last10 years, and has woken me up
the data from the Glucose monitorupdates every five minutes.
(14:21):
If someone gets eight hours ofsleep, that's 96 times every single
night, but the alternative is fatal.
I think one in 20 type one diabeticsdies from dead in bed syndrome
where their blood sugar goes reallylow in the middle of the night.
And they don't wake up even sosome diabetics are willing to take
the risk for a good night's sleep.
(14:42):
There are certain types of Type onediabetics who will go off of it.
They'll say, I'm too overwhelmed.
It's too bad for my mental health.
I asked Sarah if she thought the appcould be improved with user feedback.
No, the app, I think the app'sas good as it could ever be.
I think it's just hell to befed so much data and yet without
(15:03):
data, there is no medicine.
During the pandemic, Sarahstarted noticing her hair was
falling out more than usual.
In the midst of stay at homeorders, the only appointments
she could get were online.
But these appointments did not leadher closer to a diagnosis instead.
Her concerns were dismissed.
They defaulted to, oh, well,she's just being a little crazy.
(15:24):
She's being a woman.
You know, Sarah had already cometo expect her concerns would not
be understood through telehealthappointments, but there was one major
difference between getting care onlinefor her diabetes and for her hair loss.
The availability of data, and it's twoentirely opposite ends of the spectrum of
medical dehumanization because on the onthe T 1D end, everything is quantifiable,
(15:46):
everything is data, especially online.
When you're not interacting withme, my life gets reduced to the
numbers you see on this graph.
But for her hair loss, there was no data.
It was just her word.
Without me asking.
Sarah pulled back her hair and showedme the spot where her hair loss had
been the worst, as if she still felt sheneeded to prove to me that it was real.
(16:06):
I skipped my senior prom becauseI felt so insecure about it.
After she came to college, one ofthe first things she did was book an
in-person appointment for her hair loss.
It took her less than five minutes to lookat my scalp and go, yep, that's alopecia.
More likely than not, we have allbeen or will be patient someday.
(16:27):
Doctors intimately impact all of us.
They've been defining characters ofmy life because they've been there to
resolve or sometimes to worsen some ofthe most pressing issues of my life.
Your medical journey and care isextremely personal and sensitive.
When a physician performs a physical examor an operation, you are in a completely
(16:50):
vulnerable state that is the contractbetween the physician and the patient.
They will see you throughvulnerability with dignity.
That we're losing a ritual.
We're losing a ritual that I believeis transformative, transcendent,
and is at the heart of thepatient physician relationship.
Dr.
Abraham JE is a physician and author.
(17:13):
Ted in 2011 gave a TED talk to themost important innovation, I think in
medicine to come in the next 10 years,and that is the power of the human hand.
To touch, to comfort, to diagnose,and to bring about treatment.
And it's true.
Humans, hands built computersfrom scratch, wrote lines of
(17:33):
code that took humans to themoon, built AI like Chatt, PT.
That honestly seems like somethingstraight out of a sci-fi movie.
That's what excited me abouttechnology is how relentlessly you
can pursue and innovate with it.
Yet, in thinking about medicine only froma technical standpoint, I realized I was
missing a crucial component of medicine.
The people, technology is meant tobe explored and used fully, but it
(17:59):
is up to physicians to ensure thatwithin this technology, the human core
of medicine does not get sidelined.
I asked Dr.
Joyce what this might looklike to use technology without
losing that human connection.
First of all, one has to bepatient and to have a good ear.
Always listen to your patient, give themthe time they're need, and then just
(18:24):
truly show your love and concern for them.
There's a conflict in medicinecalled bedside manner.
It includes the tone of voice, bodylanguage, empathy, and active listening.
That helps build trust and comfortbetween patients and their caregivers.
Good bedside manner makes patientsfeel heard, valued, and supported.
(18:45):
But what about a digital bedside manner?
I have always loved innovationand technology, and there was
a time I thought that I wouldspend my life working with them.
Now I plan to follow in my father'sfootsteps and become a physician.
Still coming from a computer sciencebackground, I initially thought
technology was the key to the futureof medicine, but ultimately the reason
(19:10):
I've chosen to pursue medicine, I.
Is because I wanted to do somethingwhere I felt connected to people.
I think about my future patients a lot.
I wonder what I can do tobecome a better physician.
I found that the answer is not to beknowledgeable on and use the latest or
(19:31):
most complex technologies, but to listen.
If I could get my hairdone by video, I would.
I don't do telehealth anymore'cause that's how little I respect.
I think both as physicians and aspatients, we should proceed with caution.
There will be people like Randywho find digital connection and
technology perfectly fitting into theirlives and meeting all their needs.
(19:53):
But that doesn't mean we don't listen topatients like Sarah, who feel sidelined
and forgotten by digital health andyearned for a more meaningful connection.
As we continue leveragingtechnology, we must think.
Even more deeply about how to infusehuman connection, compassion, and
care through these new mediums.
It's a powerful lesson.
(20:14):
Pixels can't capture the full picture.
As a child, I associated the hospitalwith the warmth, love, and the excitement,
and being in the presence of my father, Ialways knew that there was someone there
that was on my side and cared about me.
Every patient deserves tofeel that way to know that.
(20:35):
Physically, digitally andemotionally, there is someone on
their side taking care of them.
So only time will tell how thesetechnologies and this modern influence of
diagnosing treatment in the digital spacewill affect both patients and physicians
and change the future of medicine.
(20:57):
The only truth is that thestory of healthcare is one that
will always be written in the.
Complex language of human interaction.
You've been listening to DigitalDiagnosis, which is produced by Priyanka
Rera as part of a Braden grant withthe Stanford Storytelling Project.
Music from Luda, blue Sessions,and sound Effects from free sound.
(21:17):
Many thanks to Sarah, Randy and Dr.
Joyce.
And Laura Joyce Davis Geral, DawnFrazier, and everyone else at the Stanford
Storytelling Project and in the BradenGrant for feedback and inspiration.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Intentionally Disturbing
Join me on this podcast as I navigate the murky waters of human behavior, current events, and personal anecdotes through in-depth interviews with incredible people—all served with a generous helping of sarcasm and satire. After years as a forensic and clinical psychologist, I offer a unique interview style and a low tolerance for bullshit, quickly steering conversations toward depth and darkness. I honor the seriousness while also appreciating wit. I’m your guide through the twisted labyrinth of the human psyche, armed with dark humor and biting wit.