Andreas Abel: the digital age demands ever more flexibility from doctors too
As today's young people increasingly prefer communicating through digital platforms over calling a doctor, doctors and the healthcare system need to adapt to that shift too, writes Meliva Chief Medical Officer Dr Andreas Abel. This inevitably puts pressure on the system to find new solutions.
Meliva has already run its first trials with digital platforms and launched its Digikliinik. Through Digikliinik, patients can get a doctor’s consultation for their own or their child’s health concern via a remote appointment. It’s the best option for anyone whose health issue doesn’t necessarily require an in-person visit to a clinic. Interestingly, the average Digikliinik user is a woman around 30 with children — though people aged 40-50 are also confident, frequent users of the platform.
Tervisekassa (the Estonian Health Insurance Fund) has also recognised the need for digitalisation, and last year began funding the use of digital service platforms (e-Perearstikeskus, Perearst 24, and Eelvisiit). By the summer of last year, half of all family doctors had already adopted these tools. According to Tervisekassa, more than a third of the population has now used digital platforms to contact their family doctor’s practice, and 86% of them have been satisfied with the service. In total, close to 736,000 contacts were made through digital solutions last year.
If we have patients ready to communicate with a doctor digitally, that requires the same readiness from doctors too. Fortunately, we have a new generation of digitally skilled doctors coming up who place high value on flexibility in their work. Working in Digikliinik is also more flexible for the doctor than seeing patients in person at a clinic.
Digital appointments support, rather than replace, in-person care
That said, Digikliinik isn’t all-powerful: in Finland, for example, Meliva’s Digikliinik initially also offered patients the option of a video call with a doctor, but only a small percentage of patients wanted to use it. That shows people still aren’t quite ready to talk about their health concerns over a video link. At the same time, people are fairly deliberate about which concerns they’re willing to phone about, when they’d rather write, and when they feel they genuinely need to meet a doctor in person.
So issues that can be resolved by communicating with a family doctor or nurse through a digital platform should be handled that way. This frees up capacity for in-person first appointments for the people who actually need them. This matters all the more because Estonia continues to see a persistent problem where people only walk into a doctor’s office once their condition has already become quite serious.
An article published in the academic medical journal Annals of Internal Medicine found that although more than half of primary care visits during the period studied (April to December 2021, in Northern California) were conducted by video or phone, the number of in-person visits also rose slightly. Whether an in-person visit was subsequently needed depended on the reason for the initial contact.
It’s clear that both doctors and patients need to be able to use digital tools well for the benefits to be fully realised. Among other things, this means that certain health issues can be resolved remotely, while others require an in-person visit. In many cases, though, that first point of contact can — and sensibly should — be made remotely, through digital platforms.
AI will never replace the doctor
New challenges for doctors are also emerging from the wider use of AI, along with patients Googling symptoms and searching for health information on social media. While doctors themselves also use AI and Google in their work, many haven’t yet adapted to patients’ new information-seeking habits.
Trust in doctors hasn’t waned, though: a Kantar Emor survey on medical brands found that Estonians trust ambulance services, doctors, and pharmacists more than any other part of the healthcare system. At the same time, one in six respondents said they fully or somewhat trust health advice given by AI. So the healthcare system certainly can’t escape the influence AI is having either.
It’s worth acknowledging that taking an interest in your own health — including searching for information online and talking with AI — is, broadly speaking, a positive thing. At times, a patient’s enthusiasm for Googling symptoms can even work in their favour, making it easier to explain a complex diagnosis to them. That said, it’s worth stressing to people that when searching for information online, it’s essential to stay critical of your sources.
AI will certainly become more useful to doctors and nurses for various administrative tasks, but it will never replace the doctor, because medicine, by its nature, isn’t a black-and-white science. Medicine still involves a great deal of so-called grey area, where decisions can only be made in collaboration between patient and doctor, since the patient needs to be properly and accurately informed about the potential benefits and harms of any given choice. The choice is always individual too, and based on trust — something AI cannot take over.
New ways of communicating aren’t enough on their own
At the same time, our healthcare system remains too case-based and fragmented: a patient sees a doctor, or communicates with them through a digital platform, gets a prescription or a solution to their concern, and leaves — often without clarity on how to actually reach their broader treatment goals. Health outcomes would benefit, though, from doctor and patient jointly setting goals to work toward together.
Here, we could learn something from Finland, where doctor and patient jointly draw up a treatment or health plan, accessible to the patient at any time through a health portal. It’s a document that records treatment goals, which the patient monitors themselves and can refer back to when reaching out to a doctor again if needed. This has been trialled in Estonia too, for certain chronic conditions, but a similar system should be more widely adopted.
For something like this to work in Estonia as well, health data would need to be more usable. Right now, we rely too heavily on whether or not a patient is able to use new platforms, and on how well a patient can piece together their own health information within a fragmented healthcare system — not to mention information found online or through conversations with AI.
The rise of AI is inevitable. As human interaction and information-seeking have moved onto digital platforms, doctors need to meet patients there too. Once we’ve managed to secure that continuity of communication between doctors and patients, the next step should be digital treatment plans. Only through close collaboration between patient and doctor, and by making sensible use of digital tools, can we move toward a healthcare system that is flexible, human-centred, and future-proof all at once.
