So I Read This on a Billboard

On my way to the car dealership for that inevitable and painful practice of buying another vehicle we all endure every few years, I noted a very seductive billboard along a busy roadway lined with fast-food venues and big box stores.

There it was, a very assuring looking physician in a white coat holding a tablet and wearing a stethoscope as a badge of legitimacy. The billboard stated:

“Confidential medical care for you when you want it.”

There was a very simple website to be accessed. This is digital medicine and is part of the medical landscape, but as they say, let the buyer beware. Getting prescriptions for erectile dysfunction and hormonal imbalance has many more implications than just answering a short questionnaire online. I’ll explain in a moment. First some background.

Once upon a time . . .

. . . the practice of medicine was largely a mom-and-pop cottage industry. A single practitioner, sometimes working out of his home (yes, mostly male from the Marcus Welby, MD, era), would provide primary care for patients and on occasion would refer the patient to a specialist such as a surgeon. The typical training of the practitioner was four years of medical school followed by a rudimentary year of internship and then the newly minted doctor would hang out the shingle for practice. In general, this was a collaborative relationship based on trust and mutual respect with the patients.

But now let us forward the tape to our current culture. Medicine now is a complex medical care and distribution system with multiple tentacles throughout the business, economic, and political environments. There is intense competition among major systems for ranking and for patients who are the consumers of the product. But now let us look into this system and what we need to know.

The foundation of medical practice is based on trust in the setting of the patient’s history, a targeted physical examination and selected blood studies and imaging such as x-rays and scans. There is no substitute for that face-to-face encounter between a concerned patient and a compassionate healthcare provider. This is based on a relationship, not on a contract or a billboard or an internet ad.

Confidentiality has always been part of the medical relationship, and it was put into law with HIPAA in 1996 (I can’t believe these privacy regulations have been in place that long or why they were needed to be mandated at all). That’s why you are presented with documents to sign when you visit a medical practice and why the doctor’s office asks if it’s okay to leave a voice message on your phone.

Would you buy a car from this person--or any person?

As I approached the car dealership, I mused for a moment about buying a car through a website without human intervention. A close friend and neighbor prided herself by saying that she purchased her last car on the phone.

Convenient? Yes. But there is something comforting about having someone there to explain the new features on the 2024 model, and taking an actual (not virtual) test drive in the actual car you wish to buy, getting the lay of the land and the view out the back window and the adjustment of the driver’s seat.

In the medical world, it works the same way. You want someone there to respond to your questions, to see you as a real person, not through an online questionnaire. And, ultimately, to get your full medical picture because the care you seek online may not be what you need.

But now let me pivot to what I am really talking about: medical illiteracy.

By definition, illiterate means “having little or no education, especially being unable to read or write.” But it also means having lack of education or knowledge in a specific area. I am linguistically illiterate when it comes to Spanish. I am mathematically illiterate when it comes to complex calculations. But this also applies to medicine and the results can be catastrophic.

When a patient has a complaint or a concern, the correct diagnosis and the appropriate treatment reflects the interpretation of sometimes nuanced physical findings, the emotional state of the patient, and myriad subtleties.

During my internship I remember a gentleman who sought care simply because of fatigue and he just did not feel well. The wise professor of medicine noticed that the patient had been tightening up his belt because he had lost substantial weight and this was a clue about the seriousness of the problem. A tablet and app or a cell phone would not pick up this finding.

Here is the critical bottom line:

• Many of us live in a hyper-caffeinated techno digitally driven world. Time and convenience are crucial currency for many.

• But when it comes to illness where the stakes are high and the risks can be high, there is no quick fix, there is no artificial intelligence or machine learning to quickly provide the answer.

• We need to understand that a robot is of little comfort at the eleventh hour.

Ignore the billboards and TV commercials that promise confidentiality and drugs mailed to you in plain wrapping. That’s not how medicine should be delivered. Beware.

Now excuse me while I test-drive yet another car.

This is what happens when you play with an AI image generator, typos and all, but you get the point.

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