Joshua Liu

One of my most memorable experiences as a 3rd year med student was caring for John.

John was a 50-year old patient with metastatic lung cancer. His prognosis was poor – he only had a few months to live.

Never smoked. No real risk factors. Just really bad luck.

John was admitted to the hospital after coming to the ER with severe pain. We were going to do our best to help control his pain, and then help him get back home.

I was John’s primary care team member during his stay. I saw him daily.

John was understandably angry and frustrated with his situation. He was short with members of the care team. He wouldn’t talk to most people.

I ended up being one of the few care team members John was cordial with. Being able to communicate with John was critical for us to improve his pain and get him home safely.

About a week later, we discharged John to the community.

Fast forward a few weeks, and I was doing an overnight call shift. In the early hours of the morning, I was called to do a consult for a patient in the ER.

It was John.

He looked much worse this time. His pain was even more uncontrolled. He could barely talk and no one was with him. It would’ve impossible to get a full medical history on him.

Fortunately, I didn’t have to. I probably knew John’s story and medical history better than any single person in the hospital that night.

I talked to him briefly and then got him admitted. During his stay, I worked with John, his family and our social work team as he made his decision to transfer to a hospice care center, so he would be better supported in his final months.

When I think back to that day in the ER, I feel grateful that I was the person on call that night. I can’t imagine how much worse John’s experience as a patient would have been if someone else had been on call.

It’s also been a regular reminder to me of how important an on-going Provider-Patient relationship is.

When providers have a pre-existing relationship with a patient, they can deliver better care because they have far more context.

One of the things I’m most proud of with SeamlessMD is that we don’t disrupt the Provider-Patient relationship. Instead, we enhance it, by allowing a patient’s own care team to extend their care beyond the four walls of the clinic or hospital.

If a patient is recovering after surgery, it’s much better for the patient if her surgical team is monitoring her symptoms and recovery – because if there are early signs of post-operative complications, her surgical team has far more context for what to expect with her specific recovery, and can treat her situation more appropriately.

Or in John’s case: imagine if his own palliative care team was monitoring his pain remotely, and could manage his pain at the earliest sign of trouble.

Over the past few years, there’s been a lot of hype about Digital Health and Virtual Care. Especially virtual care solutions built on the premise of patients speaking with the first clinician available.

This works great for low-risk or urgent care issues – e.g. rashes, UTIs, etc.

But this is not an effective approach for patients with complex chronic diseases or patients going through an acute episode of care (e.g. surgery, recent hospital discharge, etc.) – where being managed by a consistent care team with context is critical for patients to have the best health outcomes.

For the latter situations, excellent patient care is not a commodity that can be accomplished between a patient and any random provider. It’s a function of both excellent clinical skills AND applying those clinical skills in the context of that specific patient’s healthcare journey. This is especially important when caring for our most at-risk patients.

There’s a place in healthcare for both types of solutions. I just hope with the “coolness” of convenient, urgent care Digital Health solutions, that we don’t forget the importance of solutions that enhance Provider-Patient relationships – especially for patients at-risk who need care the most.