In a famous 1927 essay titled "The Care of the Patient," Francis Peabody states that the personal bond between the doctor and the patient is the source of the "greatest satisfaction of the practice of medicine." Many providers who balk at the rapid transformation of the American healthcare delivery system complain that electronic medical records and other interventions interfere with this central relationship. It is always assumed the interaction between two living human beings is central to the care of patients.
My embrace of the above conventional wisdom was first challenged by Joseph C. Kvedar, M.D.'s concept of emotional automation with its belief that humans can and will develop trusting relationships with sociable humanoid robots. My skepticism was gradually overcome by Kvedar's examples of Karen, the virtual wellness coach/avatar, who motivates human patients to exercise more than a control group, and the Boston hospital patients who preferred a robot discharge planner to a human nurse. In the latter case, the patients commented that the robot was never in a hurry and did not talk down to the subjects.
A new University of Southern California Institute for Creative Technologies study found that subjects are more willing to reveal personal information to sociable humanoid robots than to actual human healthcare providers.
The study included 269 adults ranging in age from 18 to 65 who were interviewed by SimSensei, a virtual humanoid robot designed to identify mental health issues through real time sensing and recognition of nonverbal behaviors.
One study participant stated that interacting with the robot was "way better than talking to a person. I don't really feel comfortable talking about personal stuff to other people." Another who thought that human investigators were involved in his interview stated, "I wish you hadn't told me that other people were in the other room listening in. It was weird, like, I don't even know these people. I would have said a lot more stuff if they weren't there.â€
This USC study confirms earlier findings such as a Mayo Clinic report that doctors do not do as good a job at taking a medical history as a computer. The Mayo experience was that doctors miss 55 percent of psychosocial problems, 54 percent of patient problems, and 45 percent of patient concerns.
We are just now starting to understand how humans interact with computers. Nick Yee, Ph.D., described the Proteus Effect, where video game or digital world avatars change how we behave in virtual environments and in real life. Subjects given more attractive or taller avatars disclosed more personal information and bargained more aggressively than unattractive, shorter avatars. Yee found that the subject's perception of his or her own attractiveness persists outside of the game or virtual world to affect participation in real life online dating. Yee writes that providing users with "fit, athletic avatars in exergames may encourage longer and more engaged exercise sessions than if they were provided with normal-looking avatars or avatars modeled from their own bodies."
Therapists now use digital worlds with sociable humanoid robots to help patients work through social anxiety, drinking, gambling, post-traumatic stress and agoraphobia. A therapist can discuss the patient's feelings at the very moment that the virtual bartender asks the alcoholic if he wants to order another drink, and practice different coping techniques time and time again in virtual situations that feel real. USC psychologist Albert Rizzo helped veterans with post-traumatic stress by using a virtual Humvee scenario that recreates ambushes by insurgents. "We can control the intensity of experience, and then work on the patient's response," breaking the association between reminders of the ambush and the subsequent panic the patient deals with months later.
The above examples of how trusting relationships between humans and sociable humanoid robots can be helpful in creating the new patient-centered, technology sophisticated American healthcare delivery system. The success of this approach will depend on whether or not healthcare providers and patients embrace the idea that technology can play an important role in interacting with patients. The hospital system that is open to such innovations will be at a competitive advantage compared to others who reject such developments.
Kent Bottles, M.D., is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics.