"More often than not, our patients won’t even see a doctor”
Reading: "Dr. Bot: Why Doctors Can Fail Us—and How AI Could Save Lives", Charlotte Blease.
It's a book looking at the patient-doctor relationship: where it works, where it lets us down, and where AI might fit in.
One section I want to remember describes how Iora Health in the US (now part of One Medical) uses non-physician health coaches. These are people from the community to support a patient, and "becoming their cheerleader":
If an individual with diabetes isn’t eating the right food, their personal coach will take them shopping and show them what to buy within their budget.
The most interesting part is the empathy and shared experience. As Dr Fernandopulle, the CEO, puts it:
“Most of our really good health coaches either personally have a chronic condition or have a close family member that they’ve helped with. [...] I remember several times trying to help patients to use insulin—they’re scared about the needle. But when a health coach pulls her shirt up and says, ‘Look, I give it to myself. It’s not a big deal. I was just as scared as you were the first time. I’ll be with you.’
This all makes perfect sense. What's the state of this in the UK?
The closest equivalent in England would be social prescribing link workers (SPLWs, not to be confused with physician associates). It's quite different to Iora Health. When I think of "social prescribing" I think about people being sent off on gardening courses or joining a choir—which sounds useful, yet feels like a cop-out.
I couldn't put my finger on why I felt that way until I heard Dr Rochelle Burgess talking about social prescribing.
Dr Burgess' vision, as I understand it, is about considering a person and their situation, and then addressing inequalities that are the source of some health conditions (the "social determinants of health").
For example, if you're living in a damp flat, getting similar people together and helping them challenge landlords to take action. Joining a choir will improve your mental health (if it's not hard to travel to), but not as much as fixing that damp flat.
That's a long way from what I think GP surgeries can do today. But the vision, of trying to address inequalities at their root, is a beautiful and logical extensions to what healthcare should be doing.