Dr. Bouchard

Dangerous Idea: Asynchronous Consultations

I was tagged by Jessica Otte in her Dangerous Ideas post, so I guess it's my turn to post my own submission to the College of Family Physicians of Canada (CFPC)'s "Dangerous Ideas Soapbox" as part of Family Medicine Forum (in 2016, hosted in Vancouver).

This is the part of the conference during which physicians can share radical ideas for change in primary care. Four abstracts are chosen and presented, and the successful ideas are later published in the Canadian Family Physician; see 2015's Dangerous Ideas.


My idea:

We all know technology in healthcare moves at a glacial pace, and the way technology and our lives interact outside of our work has evolved to be drastically different from what happens in clinic settings throughout Canada. The nature of the typical patient-physician interaction hasn’t fundamentally changed in 100 years. But what if we made some common-sense, relatively low-tech changes to how our clinics run? Almost everyone my age or younger keeps in contact with family and friends on a daily basis effortlessly through text and Snapchat.

What is stopping us from communicating with our patients in this fashion, and more importantly what is stopping patients from initiating this type of interaction themselves? I would posit that most healthcare issues are continuous rather than episodic, and that an ongoing, thoughtful conversation with our patients would significantly improve the quality of the care they receive. Texting comes naturally in the modern era to most, and the key to it's explosion in popularity is its asynchronous nature. In the context of healthcare, this means that my time as a physician is used much more efficiently, saving the healthcare system as I fit ongoin asynchronous conversations in between my traditional in-person visits. My patients and I can engage in the conversation when most convenient for each party. We can both take time to think about our questions and answers. The patients have an ongoing and permanent record of our conversation, and subsequently are able to recall 100% of what we discussed, rather than the perhaps ~30% of what we discussed during an in-person consultation.

Now, this isn’t all positive: not all medical problems can be handled over text, and certainly not all patients want to engage with their physicians in this way. But pioneering clinics in the U.S. have seen upwards of half of in-person visits disappear when patients have the option of ongoing, asynchronous care, and this will likely increase as a greater proportion of the population becomes comfortable with the technology. I believe asynchronous care will be a core component of good primary care in the not too distant future, and will be a source of significant healthcare outcome and system cost improvements.