Behavioral Tech May Be Indispensable, But Is It Self-Sufficient?
Technology is an indispensable part of healthcare. This is true even for fields built on personal connection and communication. The key question is how much autonomy we should give technology. Behavioral healthcare might benefit from automation and artificial intelligence (AI), but tech products must ultimately be tied to our foundation—therapeutic relationships.
An analogy crystallizes this idea: The clinician is always the pilot, however sophisticated the cockpit.
We need not worry about technologists programming their chatbots to engage in seemingly empathic dialogue. No harm will result from challenging computers to surpass our best diagnosticians. Yet one limitation applies. However much our clinical activities are advanced by such products, it will always be essential to return to the perspectives of clinician and client.
Consider a real example. My primary care physician (PCP) told me I might need a statin to prevent cardiovascular disease (CVD). He disclosed that the computer algorithm he uses during clinical exams suggested this. He was puzzled since none of my lab results indicated risk for CVD. He persisted in checking and found the algorithm was responding primarily to my being in my 60s. This initially troubling discussion ended well.
The algorithm was simply summarizing data. The risk for certain health problems grows with age, and some medications can help. My doctor was transparent, honest, and open to my decision after sharing this information. This is a comforting interaction for anyone worried healthcare will ultimately be ruled by computers. My doctor never doubted he was the pilot. The route to be charted was my decision.
Pioneers in our field are using artificial intelligence and the processing of spoken language to simulate empathic responses. A major goal is to help train and supervise new therapists. This may prove to have real value, and yet the supervisor never loses authority as the final arbiter of whether a trainee actually possesses the skills needed to be a competent therapist.
What about freestanding digital therapeutic programs? Health plans and employers fund and promote their use, and these products could be allowed to replace access to in-person or virtual therapy for segments of the population. Clinical studies show meaningful clinical change for many people using these products. It is tempting to use them as independent population health solutions.
However, this is a slippery slope. Pilots are missing in this scenario. Needs are great and so other concerns dissipate. Do we not want better access and lower cost for consumers? Why not have virtual services (cherished during the pandemic) as lower-cost alternatives to in-person care? This is being actively debated in both behavioral and primary care, where telehealth has made the greatest strides.
Thought leaders are starting to push back on the trend toward self-sufficient technology solutions. They are reaffirming the essence of healthcare:
Telehealth services function best when connected to and supported by healing relationships. To put forth new primary care models, as many payers are doing, that engage people in telehealth divorced from underlying clinical relationships will not provide the comprehensive primary care that people need.
There is nothing stopping payers from offering products “divorced” from the more personal elements of healthcare. The federal government will be slow to regulate behavioral or primary care delivery since no single agency has accountability. We need industry and consumer leaders to push for comprehensive care for all patients. They must beware of misleading arguments about technology.
It is hard to overstate the need for behavioral healthcare to be more accessible and affordable. However, this cannot justify losing therapeutic relationships. It is not anti-technology to insist the emerging world of computer-driven services be offered in a context of professional relationships. It is not regressive to argue a connection to caregivers must be maintained with such products.
Investors often have a technology bias, and they are unconcerned about products staying grounded in healing relationships. Entrepreneurs like technology partly because discrete new products are easily understood and readily hyped. Many clinicians today view tech investments with chagrin, but not due to technology concerns. They simply want resources invested in care providers to keep pace.
We should remember some basic realities. Investment frenzies are temporary and products are susceptible to fads, but people are always essential in healthcare. This is one reason why smart employers have consistently invested in the health of their employees. They understand the value of human capital. This is often more valuable to a business than tangible assets like new equipment.
Let us push computers and analytics to their limits. They can probably improve our work in ways not yet imagined. There was a time when no one imagined robotic surgery. We will similarly be surprised by the unforeseen use cases for artificial intelligence in our field. Yet just as surgeons control the robots, clinicians must control the technological advances enabling behavior change and psychological healing.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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