A human doctor is a critical component of creating change in patient behavior and health.
What was missing when an intervention, rooted in the psychology of behavioral economics, bolstered by technological innovation and designed by experienced clinical researchers, attempted to improve clinical outcomes and medication adherence in survivors of acute myocardial infarction?
Using a wireless pill bottle, daily lottery incentives, family and friend support, and a social work intervention, investigators from the Penn Medicine Center for Health Care Innovation were unable to demonstrate any statistically significant differences in cardiovascular events or medication adherence in 1500 patients across the U.S. There are many possibilities for why there was no improvement using a combined intervention, which is the full discussion of the article.
But a key element is that the intervention had no direct involvement of a clinician! No Dr. Chatterjee asking if you brought your meds today. No slight look of disappointment when you can’t name a single medication you’re supposed to be taking—followed by a smile, a query as to why you don’t know your meds, and if there is anything I can do to help. Then a brief education on the rationale of these medications and finally, encouragement.
In this study, patients were certainly tracked, monitored and observed, but not by a physician. Not by a person whose essence, training, and job is to practice humanism.
It’s something that’s difficult to measure, but maybe the failure to measure a change in the absence of that feature is important.
It’s easy to get caught up in the excitement of new ideas, new technology and the dream of doing more with less. This type of evidence reminds us of the centrality of humanism in our profession.