Skip to main content

Remote work during the coronavirus pandemic has immersed doctors in technology, perhaps accelerating its integration into medical practice — but not necessarily its acceptance or authenticity.

I tend to doubt the veracity of much of what I read in electronic medical records. I also question reports based on data gleaned from large medical databases – for example, summaries of physician compensation and practice trends.

Many reports that profile doctors are generated on professional websites independently or with the help of self-proclaimed “high-tech” companies. They border on self-promotion, and data integrity may be compromised and deemed too unreliable to be credible.

The adage “you can’t always believe what you read” is truer today than it has ever been, and studies have shown that much of the medical information on the internet is incorrect. or misinform the public.

Data collected to assess practice models may be incomplete. The sampling method may be biased. “White papers” are rarely peer-reviewed and often lack statistical review and analysis. Observations often replace ironclad facts.

For example, Doximity published a report—unsolicited, of course—comparing the top specialties chosen by students at my alma mater medical school in 1980 with the top specialties chosen by students in the current class. I noticed a few inconsistencies, so I raised the alarm to the “support specialist” on the website.

The specialist replied, “Thank you very much for your suggestions and comments on this data report. We have forwarded your message to our product team for review. We always strive to make our tools as useful as possible for doctors.

In a Machiavellian moment, I recalled Henry David Thoreau’s prophetic statement in Walden: “Men have become the tools of their tools. Don’t let it happen, I tell myself.

Then I realized that Thoreau’s words already ring true, given the alarming number of problems associated with electronic health records – increased provider time, computer downtime, interrupted patient interactions, lack of privacy standards and threats.

The reliability of the medical record has dropped due to errors in documentation caused in part by multiple user entries and “copy-paste” errors.

In my specialty (psychiatry), virtual mental health startups are all the rage. Most are privately funded. The companies seem infatuated with technology and boast of their ability to “democratize” mental health services by reaching millions of patients.

However, digital mental health care companies feel sterile and can be counterproductive to the benefits of in-person psychiatric treatment.

Mental health businesses that operate 100% online may be required to access patients in remote locations or when demand is high, but distance exposes patients – now called “clients” – to the ever-increasing dangers of psychiatric treatment virtual: unanswered calls for help – sometimes from suicidal patients – and inappropriate prescribing of controlled substances.

Working at investor-backed telehealth startups has been chaotic and confusing compared to working at fast food chains. A whistleblower alleges that a company’s policies and practices may have put profits and growth ahead of patient safety.

It is telling that companies that provide virtual psychiatric services embed legal disclaimers into their websites explaining that the services provided are administrative, financial and support only. The fine print also makes it clear that their services do not deal with emergencies and that their providers are in addition to local primary care providers and do not replace them.

The new breed of tele-mental health companies cite positive results in patients who use their services. Patient testimonials adorn their websites, and again questionable – surely not statistically significant measures – are referred to as de facto indicators of clinical improvement.

I’m a fan of medical protocol and precision because after working a dozen years in the pharmaceutical industry, I saw how advertising claims could be easily manipulated and twisted for commercial gain and end up becoming false statements.

Claims made by healthcare companies online — on television, on social media, and on their websites — should be subject to the same scientific scrutiny as pharmaceutical claims when submitted to the FDA. All claims of efficacy must be truthful and not misleading, supported by sound statistical analyses.

I am not anti-technology. In fact, I’ve seen firsthand the benefits of technology when used constructively in the pharmaceutical industry. The collective move towards decentralization – carrying out part or all of the clinical trial in patients’ homes – coupled with the investment in technological innovations that make home visits and data collection possible is changing the face of clinical trial development.

However, I am against using unproven or inferior technology with issues that compromise patient well-being. There is not – and probably never will be – an all-in-one digital technology company that allows providers to capture results and diagnoses, leverage links to data modules decision support and medical literature, and to communicate with colleagues and others caring for the patient without the semblance of human contact and without the potential need for real-time intervention. Processing cannot be provided indefinitely in cyberspace.

The participation of clinicians is crucial to successfully designing and implementing medical applications and electronic health records. Clinicians also need to engage and be visible in digital environments. Care received entirely through online messaging is dangerously promoted as good as that provided in the office – despite the huge differences between the two modalities and a host of limitations associated with mental health teletherapy.

Non-clinician-based digital mental health services such as chatbots, video and written content, gamified user exercises, and digital cognitive behavioral therapy programs will never replace clinician-based, face-to-face treatment. No matter how much of a doctor’s work can be replaced or aided by technology, the human touch will always remain a prerequisite for patient care.

Arthur Lazare is a psychiatrist.

Image credit: