Would You See a Holographic Doctor?

Imagine if instead of schlepping across town to your physician's office, spending a half-hour in the waiting room leafing through a year-old National Geographic, and spending just long enough with the doc to get a prescription, you could instead request a personal house call in the form of a hologram. Or talk to an artificial representation not only possessing your doctor's knowledge, but all the research contained in medical databases.

Well, if the “virtual care clinic,” now in the works at the University of Southern California, opens for business sometime later this year, we're going to find out.

The plan is to combine real physicians, their visual representations, and artificial intelligence into one badass caregiver, providing patients access to not only a wealth of routine and specialized information, but also to virtual doctors who don’t get cranky when you ask, “So can I, like, die from this?" Patients will transmit  information about their physical condition through body sensors.

What will this look like? Well, take a look at the videos below, where you'll see patients who want more information about their condition or treatment as they connect with electronic versions of their physicians.

In the first demo, a video version of a real doctor asks the patient which treatment outcomes concern him the most. When he chooses “survival mortality,” the "doctor" searches its database and pulls studies of patients with a similar profile. She then reports that a new medication for his condition reduced mortality 9 percent more than an older treatment. That, coupled with a reduced risk of stroke, leads the virtual physician to recommend the newer medication.

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In this demo, an avatar with a computer-generated voice gives a patient with prostate cancer the mortality rate for radical prostatectomy as compared to the rate for active surveillance.

And apparently holograms are also on the table ...

“By allowing people to access doctors on their own time, it can create an interaction that’s been missing from medicine,” said Dr. Leslie Saxon, the executive director of the University of Southern California's Center for Body Computing, which is creating the clinic in partnership with the USC Institute for Creative Technologies and Keck Medicine of USC. In addition, there are eight “foundational partners," which the clinic announced last week.

Saxon believes  this sort of remote, virtual care will become the "dominant global health care solution" because of the benefits it will provide for physicians,  patients and the bottom line.

By “virtualizing” the knowledge set of experts, she said, “we can provide access to [them] at a fraction of the cost. We can take care of more and more patients virtually and save the brick and mortar visits for those that really need it.”

Saxon also thinks enabling appointments from anywhere patients can use a smartphone will relieve many of the burdens involved in traditional encounters, including having to leave work to travel to the doctor and the inability to have all concerns addressed in a time-sensitive, sometimes intimidating environment.

Then there's the democratizing aspect.

“There are only so many medical experts in the world,” Saxon told the Voice of America in an interview, "and we're never going to have enough to supply the need of the entire world. So we can clone, if you will, many of the experts to provide care anywhere anytime, without borders."

What About The Human Element?

All right. Do I really want a computer to compel me to “say ahh”?

“We’re not saying you don’t need [human interaction],” Saxon said. “But you don’t need it for everything. What people like is convenience and continuous access.”

Saxon said the early data shows patients have responded well to this type of interaction.

One of the reasons, perhaps: a virtual doctor doesn’t get annoyed.

“I’m a cardiologist," Saxon says "I see 30 patients at a clinic, I’m describing the same information a lot. Do you think I’m as fresh at 4 p.m. as I am at 8 a.m.? I like the idea of being able to standardize my behavior and conduct. "

What About Privacy?

Considering that all these interactions would take place online, I asked Saxon how the clinic could ensure privacy.

“We work only with HIPAA compliant partners that have a high level of security required for the transfer and storage of digital health data,” she said

What Do Doctors Think About "Being Virtualized?"

When I described the virtual clinic to the AMA, it seemed a bit like, "that's a new one on us." But I sent some info and they emailed me back a response, "While the AMA has not reviewed the virtual health service that you describe, we would be interested in how this health care delivery model is addressing some of the challenges that occur in telehealth: no serious history-taking, no patient evaluation to guide a proper diagnosis, no counseling, no monitoring or assessment of a treatment, and no semblance of a true patient-physician relationship."

I also wondered how a regular doctor, not particularly connected to the tech world and who has seen a ton of patients, would react to the ideas in play here. My pal Dan O’Connell, an assistant professor of family medicine at Montefiore Medical Center in the Bronx, New York, fit the bill. He sees  about 25 patients per week and supervises residents who treat about 45 more patients. Most of this clientele is low-income.

He wasn’t particularly impressed by the demonstration videos. One of the main tasks of any medical interaction, he said, is to see if the patient actually understands what you are talking about.

“The virtual doctors are only some pre-set scripts with no interaction or intelligence at all,” he said. “Most effective education is an interactive conversation."

He thought the demonstration of the doctor providing the respective mortality rates for Coumadin and New Oral Anticoagulants showed the system’s limitations.

“Because the conversation is so central to the doctor-patient relationship, this particular example is useless -- it spends a lot of time and clicks to basically say, ‘the very expensive one is slightly better’ without individualizing.”

“I'm sure they will get better at this,” he said, “but the early basic assumptions -- that patients want an avatar to translate epidemiology into high school math -- misses what people want from their health provider.”

I guess we'll have to see how patients respond. If enough like this model of care, well ...

Remember this guy from Star Trek Voyager?

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