We humans, by our nature and through nurture, are social animals. Networks of family, friends, and work associates are essential to our physical and mental wellbeing, and it has been documented that loneliness has a greater impact on life expectancy than smoking. We need to engage richly with a varied community of people in order to thrive. That richness comes in many different forms, via many different points of connection, but there has to be some coherent continuity in those relationships in order for them to achieve the status of meaningful. Exchanging messages with a bot or having a one-off “visit” with a stranger doesn’t quite fit the bill.
In my last post, I looked at the meteoric rise of generative AI in general, and its potential role in healthcare specifically. Prior to that, I was looking at the retailization of primary care, as demonstrated by the increased interest in and rapid growth of transactional clinics. Exciting and novel as they may be, these new technologies and models should be seen as tools to enhance and improve a provider’s delivery of primary care, not as replacements for that provider (and the provider-patient relationship) altogether. The overall trend here—which also includes the many flavors of telemedicine—is the promotion and dissemination of “solutions” as unfortunate distractions to the real investments in foundational primary care.*
Arguably, much of this is due to self-inflicted wounds from within primary care itself. Our society has unfortunately become desensitized to the current, dismal experience of much of traditional primary care. Generative AI and transactional clinics seem responsive and modern. They offer patients the ability to access care comparatively quickly. Their virtual and physical environments for the treatment of a limited set of conditions are an improvement on the typical underfunded and under-resourced primary care practice. Is it any wonder that the investment community would irrationally overinvest in these solutions?
Despite the desperate state of primary care today, I struggle to imagine what “health as it should be” would look like in a world of AI-driven chatbots, quickie health service delivered 20 feet from the shampoo aisle, or a random online provider delivering one-off, standalone care. For primary care to be effective, it has to be based on a meaningful relationship between provider and patient, which extends beyond the transactional nature of a “visit” (more on this later!). Someone in the care chain needs to maintain an ongoing (longitudinal), continuous (connected), and holistic (comprehensive) view of the overall, underlying, and predicted health of an individual.
Who, in the increasingly faceless world of transactional care, is signing up to do that?
Our point of view is that the relationship focus from a care team can and should be an important part of care and the care delivery process. The goal doesn’t need to become close personal friendships with your care team, but the strength of the relationship we establish with a physician, a nurse, or other care professionals is a vital component of health and a healthy life. In a meaningful relationship, the care team is not simply providing algorithm-generated recommendations, data-driven insights, or other forms of digital intermediation. Instead, with the benefit of experience (and time!), a care team can employ the “elixir of empathy,” which is the warmth that makes care “human” and ultimately, healing.
Jack Dorsey, Twitter’s founder and former CEO, once said that “the best technology disappears.” It should operate so seamlessly as part of the human experience that we stop noticing its presence. That’s how the role of technological tools and abilities should be seen in healthcare: as augmenting the skills, reach, and time of the care team, as well as amplifying the healing power of a meaningful relationship with a care team. This amplification and augmentation is where these new tools, new business models, and new care innovations should be pointed. They should not be seen or used as ways to cut corners and cut costs, but rather as ways to make solid but seamless improvements to the relationship-based foundations of Primary Health done right.
If Medicus Ex Machina is the dystopian future, then Hominus Auctus (“the human augmented”) is the alternative, optimistic reality that we must focus our limited resources on creating. This is where most of our investment should be going: to first principles of health, to the root causes of systemic care delivery challenges, and ultimately, to implementing high-quality primary care that augments and amplifies human care.
* Foundational Primary Care can best be described by the book “Implementing High Quality Primary Care” that was produced by NASEM in 2021. Their definition for this type of first principles, root cause care is: “High-Quality Primary Care is the provision of whole-person, integrated, accessible, and equitable health care by interprofessional teams who are accountable for addressing the majority of an individual’s health and wellness needs across settings and through sustained relationships with patients, families, and communities.”
The report describes 5 objectives in implementing this model of care:
- Pay for Primary Care Teams to care for people, not doctors to deliver services
- Ensure that High Quality Primary Care is available to every individual and family in every community
- Train Primary Care Teams where people live and work
- Design Information technology that serves every patient, family, and interprofessional care team.
- Ensure that High Quality Primary Care is implemented in the United States
Scott Shreeve, MD 