Anywhere, Anytime

We live in an increasingly connected and technologically immersive world. Patients and physicians are accustomed to obtaining information and services in our personal and commercial lives on demand, on any device (mobile or stationary), anywhere, anytime. No wonder, then, that this “uber”-mobile (yes, the pun is intended) ethos is beginning to translate into the way patients seek healthcare and the manner in which we deliver it.

The “Anywhere, Anytime” patient—call her “Annie”—learns about aesthetic services through a banner ad she saw on her iPhone while standing in line for her morning coffee (paid for, naturally, with a mobile app), after having worked out wearing a FitBit connected to her nutritionist's web portal application for life coaching. Mildly intrigued by the notion of treating her nascent wrinkles, she visits Yelp! to check out a plastic surgeon's reputation and corroborates what she reads on RealSelf, Real Patient Ratings, or another portal that features testimonials and crowdsourced medical advice. She picks the doctor's website (let's call him “Dr. Sayed”) to bookmark and later, likes his Facebook page, and follows him on Instagram and Twitter (some providers are sending time-limited Snapchats to patients in even more spontaneous, in-the-moment bite-sized snippets of patient education and marketing). Every #hashtag pertinent to Annie's cosmetic interest (let's say, Botox) floats across her iPhone screen as she sits down to work on a laptop that she can use to ZocDoc (it is not a verb, but it is now) the doctor's office hours and make an appointment. The doctor, fresh out of the operating room, sees the rarely available slot on this afternoon's office schedule fill up as the patient books her appointment without needing (or necessarily even wanting) to speak to a human being. Somehow, inexplicable to the patient, her Google calendar is suddenly aware of her appointment and blocks off the corresponding hour, which is conveyed to her simultaneously on her iPad, laptop, and Smartphone.

The scheduling event triggers a secure email notifying her that a portal login has been set up for her to enter her medical information that will go right into the electronic health record at the doctor's office to save her even more time at the appointment.

She takes an Uber to the doctor's office knowing from her Waze app that traffic to the doctor's office is heavy and she wants to get work done in the car. After being quickly checked into the office and having her photo taken by the tablet device at the front desk, her whereabouts are made known to the doctor via instant messages from the office practice management software, which is tracking the flow of all patients through the office. She hops on the doctor's wifi network to make the most of each of the three minutes or so she will be waiting for the doctor in the exam room, summarily ignoring the AppleTV running the doctor's YouTube channel on infinite repeat in order to “check in” her location on Facebook. Her social media friends, notified of her current location, Google “Botox Dr. Sayed” to find out if she is in good hands.

The doctor has reviewed the front desk photo and EMR information outside the room and now consults with the patient, teaching her with anatomic drawings made right on her photo on the iPad and broadcast onto the LED screen in the room. Screenshots will be available for her review at home via a HIPAA-compliant messaging app like DocBookMD, should she want copies. She reads and signs informed consent and has her credit card scanned with Square, all on the same tablet device in rapid succession while she has numbing cream put on. The Botox injection proceeds flawlessly (natch). The doctor gives her a GoogleVoice number she can call after hours with questions (the doctor no longer need pay for an answering service in an Uber economy where middlemen are dispensable). After an uneventful afternoon at work, she forgets that she meant to ask the doctor about a bothersome mole. She calls the number he gave her and he calls her back within a few minutes to direct her to download an application to help her photograph her skin lesions for appropriate dermatologic review and notifies her through their messaging app that he is referring her to a dermatologist down the street, including a GoogleMaps link to the office address.

Impressed, and pleased with her Botox injection experience, she goes online to review the doctor at the same site she first learned of his practice, and the cycle continues. The doctor, having finished a long day, goes on to write an article for an aesthetic journal dictated entirely to Siri mere hours before the publisher's deadline, from a Bluetooth headset while he carefully obeys California driving laws.

Tim A. Sayed, MD is a double board-certified plastic surgeon in California and Florida. He works in the healthcare technology space as a developer, consultant and investor.