Continuous glucose monitoring is gaining traction in the management of type 2 diabetes. And with that primary care doctors are picking up the role of helping patients manage their diabetes. Katie Palmer of StatNews tells the story here.

The piece on continuous glucose monitoring highlights a couple of emerging issues in clinical care: 

• Health professionals are not prepared for rapidly changing landscape. Technology is advancing faster than doctors and systems can keep up with in medicine. And it isn’t a question about whether doctors can adjust. It’s just that the processes needed to help with this kind of adjustment just don’t exist. Collectively we’re not nimble enough to adjust.
• We’re beginning to watch data from patients as much as watching patients. The work of a physician is moving from patient contact based on a once-a-year physical, phone messages, and refills to real-time engagement with certain populations of patients. Helping patients to manage their health day-to-day creates a kind of data confrontation that changes the process of patient care.

Continuous glucose monitoring leads to a kind of data confrontation

Another example of data confrontation comes with personal genomics. Bring your 23andMe questions to the average doctor and see what you come away with. The Series 4 Apple Watch really exposed the issue when patients began sending rhythm strips to their doctors. Add to this the piles of other health data patients are accumulating from monitoring devices and you can start to imagine how a doctor-patient relationship might start to look really different.

More importantly you can see how a doctor’s work starts to look really different.

The responsibility to adapt

So where does change come from in the clinical encounter? Who’s responsible for adjusting the system so that patients don’t get left behind?

• Health professionals. In addition to the other things that we’re responsible for, doctors and advanced practitioners have got to stay current with these shifting practices. What we learned in training is not what we’ll be doing in 5 years. Or even next year. This is a professional survival issue. If you live and die by what you were trained to do you’ll be doing the wrong thing for your patients. After that you risk professional irrelevance.
• Health systems. Systems that employ doctors and practitioners need to recognize how real-time data from patients is changing the nature of a clinician’s work. This needs to be factored into daily work flows as well as in the assessment of clinical productivity and quality. Systems need to play a role in seeing that clinical operations (and its doctors) adapt to the latest advances.
• Medical education. Undergraduate, post-graduate and continuing medical education need to adjust their curricula to the realities of modern clinical age. Are our trainees prepared to manage the patient with a CGM? If not, why not? And how should training programs today prepare for this reality with their incoming residents?
• Technology industry. I suspect that AI-driven decision support will ultimately save the day here. The software isn’t quite there yet to do the heavy lifting for primary care docs. But decisions like what to do with an unexpected variation in blood glucose will be in the hands of patients or be automated with their personal devices. Which is fine. 

But still as health professionals we need to know how to work with these tools since we’ll be working in and around them. 

If you think that evolving in-line with technology is an option for doctors, there’s a market waiting to offer what we won’t. Remember that as the pieces of what doctors used to do continue to get outsourced the hole of professional identity only gets deeper. 

All of this will get more challenging as the foundation of clinical care shifts to real-time, tech-mediated care.