Virtual Drug Rehabs. They’re Coming.

Alcoholic avatars and penny pinching insurance companies – a match made in heaven.

None of us would complain about less time spent wasted in doctor’s waiting rooms, or better and more affordable healthcare! Emerging internet based interactive platforms promise to increase our access to health information and healthcare participation, while allowing a finite number of doctors to treat as many patients – more comprehensively and effectively.

We are not the same group of patients we were 15 years ago. Who goes to the doctor now before taking a self diagnostic tour of internet medical sites? We often scare ourselves with misdiagnoses of terrible diseases, but we endeavor to get informed and by doing so we participate better in the healthcare process – and at its best, healthcare is not passive, but interactive.

The potential for positive change is great – but will the pendulum swing too far? As interactive net based communication between patient and provider improves, will financial pressures compel the e-sourcing of things that just don’t make sense? Will we soon see virtual drug rehabs?

The Good – Where E-Care Makes Sense

Simple and effective online pain management platforms where patients can communicate their symptoms in real time, and longitudinally, to their doctors. Pain patients can create what is essentially an online pain diary – and as they experience pain on a day-to-day basis, they can record information about their symptoms in their diary.

It’s collaborative too. Doctor’s can log on, and given permission, access a patient’s diary, see what’s really happening, and even write notes to the patient in their diary – on a day-to-day basis. Great stuff – It just makes sense. No need to try and explain a history of pain in a 15 minute office appointment, that’s a pretty tough thing to do. Doctors get to see what’s really happening, can make better diagnosis’s and can react to changing symptoms in real time. It provides a way for more accurate information sharing, it saves money and everyone’s time, and it allows doctors to treat their patients more effectively.

That’s the kind of stuff we need. Platforms that improve healthcare efficiency while at best also improving the standard of care, or at the very least – not reducing it.

Except for the very rich, in any country you can name, healthcare systems are overburdened. Resources are finite and never enough to provide optimal care to all that demand it. It’s a fact of life, and for now, it’s just a case of managing the shortfall.

Internet healthcare systems could free up such enormous resources of time and money – ensuring that those that need a hospital bed and a doctor’s care get it – and those that don’t, stay home. How many parents, after some deliberation, make a midnight trip to the emergency room in search of treatment for something that they are 99% sure is not serious? For parents, a 1% chance of tragedy is more than enough to justify a few hours of inconvenience and 99 wasted trips out of a hundred.

On an individual basis, this makes perfect sense – but systematically, it strains resources – and strained resources mean lessened care for everyone.

E-based diagnostic platforms, staffed by doctors and nurses, serving as a front line operation would make sense, and in some jurisdictions, already exist. Get on the video phone, explain the situation, and a lot of the time, they are going to be able to tell you with certainty that there is no need to go to the hospital.

How about on the back end? How many hospital beds stay filled each year by doctors pretty sure that the patient could go home, but wanting one more day of observation – just to be certain. What if those patients that doctors were almost sure were going to be OK – were released one day earlier, but remained linked via web based diagnostics tools? The doctor could still monitor the symptoms in real time – could get someone back to the hospital if needed, but tens of thousands of beds a year would be free to people waiting for them. Better health care for all. Some people would die, but many more people would live – saving more lives for the same expenditure.

The Bad & When Only Face-to-Face Will Do

In the short to mid range future, you need not be terribly imaginative to envision the sort of benefits that interactive net based healthcare services could result in – the two suggested above are only the tip of that iceberg. But there are certain services that do not lend themselves well to distance interaction. Poisoning, trauma, pancreatitis – you can name thousands of conditions that, if you had one, you’d probably want in-person and face-to-face medical care for.

What about addiction counseling? I’d argue that although less obvious and dramatic, it also requires in-person treatment for any real odds of success. I’m not talking about detox, which obviously demands medical supervision; I’m talking about the nuts and bolts of long term treatment – group therapy, cognitive therapy, psychotherapy, etc. A case could be made that such forms of counseling could be provided more cheaply, and with little loss in efficacy, using internet communication technologies. Actually, a case will be made, and e-rehabs are likely on their way.

Addiction though, is tricky. It’s a gestalt kind of disease, in which the sum of the parts never seem to equal the whole, and a disease that demands treatment of a psychological intensity that matches the cognitive manipulations of the disease.

You could arrange for an internet based group therapy session. It would be cheap and easy, but it wouldn’t work very well. Group therapy works when participants are fiercely and honestly involved. You don’t get that when tuning out is as easy as checking your email as you sit in therapy; and manipulations don’t get spotted as they do when you squirm, lying, in person to a group.

You could conveniently get individual therapy at home, over the internet; but the trust building needed for effective counseling takes time in the best of cases, and a situation where the patient is miles removed from the therapist – is not the best of cases for relationship formation. And forget about what our non verbal communication would otherwise reveal.

Could you learn how to make sober friends again, online? Would you really do that yoga – if no one could see what you were up to? Would you tune out, when you didn’t like what you were hearing – sometimes people need a little push to make a breakthrough, but it’s a lot easier to close your browser window than it is to walk out of a therapy session.

Logistically, online addiction treatment is a cakewalk – online addiction treatment that works may be another story.

The Ugly & Financial Pressure

Interactive net communication will create savings opportunities. Ideally, healthcare e-sourcing never harms patient care. The selective application creates a higher standard of individual care in certain areas, and areas unsuited to the application of the e-sourcing benefit from increased funding from the savings – An opportunity for better healthcare, for all.

But if the potential savings in any area become significant enough, there will undoubtedly exist pressure to accept an erosion of healthcare quality in the face of savings – or to put it more bluntly – profit.

Already, consumers with excellent private health coverage who want to get residential drug treatment find that they are obliged to try outpatient first, for a long while, before their insurance company will fund a residential stay. Once insurance companies have an even cheaper option, it’s hard to foresee how they won’t compel us to use it first.

Addiction treatment isn’t like a lot of other disorders. If you had cancer, and the insurance company forced you to try a less expensive procedure first, prior to allowing the more intensive treatment – if that first one didn’t work, you’d be ready that next day to sign up for the better one. Alcoholics and drug addicts are more easily discouraged (or their disease is better at manipulating their behavior) and if the first treatment doesn’t work, odds are it will take a while (if ever) before they approach a second round. A very cynical person might suspect that insurance companies are counting on this…

It will be interesting, and great changes in healthcare over the next decade are a certainty. Most will be positive. The potential for great advances in systematic levels of care exists through the selective application of resource saving distance treatments. There will, I suspect, be an ugly side to it though, and I’d wager virtual drug rehabs will be at the head of that, unfortunate, pack.

I hope I’m wrong though.