News stories are replete with examples of increasing capabilities and practices toward personalizing medical care.  Thanks to genetic testing, it is becoming possible for physicians to vary their prescriptions and medical treatments based on a predicted probability that one option will work better than others.  Risk detection can increasingly identify patients at special risk of cancer and other deadly diseases based on genetic predisposition, and gene altering treatments for such risks are being actively sought.

Of course, the notion that health care should be personalized to individual patients has a long history, with frequent criticisms of “assembly-line” medicine for efficiency, or “cookbook medicine” for uniform quality.  Added to professional norms and practices that promote treating each patient as unique is the growing power of patients to influence the care they get based on their own individual values, life situations, and preferences.

But “personalizing” has more than one meaning, so “de-personalizing” health care has, as well.  One common meaning involves the extent to which health care is delivered by persons, and in “personal” contacts between provider and patient.  It is this kind of personalization that is moving in the direction opposite to that of tailoring care to individuals.

For example, it is becoming common practice in surgery to employ robots that can perform risky surgery with greater safety and precision than can surgeons, themselves.  Other forms of robots may cruise the halls of hospitals to deliver items needed or enable patients to be monitored.  Remote monitoring of patients in their homes is becoming an increasing practice in proactive disease management.  British researchers are developing a mobile phone that can check and send patients’ vital signs that are monitored and responded to be remote physicians and nurses.

Because personal visits to providers run up costs, there have been many “impersonal” alternatives recommended – from e-mails to home monitoring devices that cut down on visits.  Of course, providers who depend on such visits for revenue tend to have a less positive view of the idea.  When it comes to proactive health care, in particular, however, which often generate no revenue, the use of impersonal alternatives is growing.

One popular option that has been in use for many years is the group medical visit, which involves face visits, but group vs. personal attention for a major part of the interaction.  Even group phone sessions can be used to spread the costs of the professional coach or counselor over many patients at once.  But perhaps the biggest “de-personalizer” is the combination of automated analysis and computer-generated online communications that is growing in its applications to proactive health management (PHM).

By having individuals complete health risk assessments on paper or online that are analyzed by computers, PHM providers can dramatically reduce the costs of such assessments, and of analyzing results to identify the relative risk/reward potential of individual patients.  These same computers can then be used to generate “personalized” messages to individual patients that are truly customized to each one.  But by using e-mail or postal services to send them, they are “de-personalized” in the other sense of the word.

Because the costs of PHM have a great influence on the returns on PHM investments by insurers, governments and employers, the dramatically lower costs of impersonal communications (often one tenth or even one hundredth that of personal contacts), is preferred for all but the most difficult cases with the highest risk/reward potential.  And there have been studies indicating that the results achieved are often comparable to far-higher-cost alternatives.  As PHM spreads from disease management for a small portion of the population to health management for all members thereof, this de-personalization is sure to continue, and who is to say that is a bad thing?