by Dr Shashi Ponraja
Some say the future of medicine is bright. Health science has accomplished the impossible. HIV is no longer a death sentence, many infectious diseases are treatable or preventable, and we can stent a blocked coronary artery within two hours of discovering it. Others will tell you it is terrifying. The cost of healthcare is rising, threatening to economically cripple the first world. We’re faced with crises in how to manage the aged, the mentally ill, and those with "lifestyle diseases".
Many say that technology provides the solution to the crises we face. Others want to ration healthcare to those who "truly deserve it". These solutions are inadequate. Any tool we create is only as good as the person using it. As clinicians, we seek to provide the best healthcare, without discrimination. I see a future where technology and culture revolutionise medicine. A future focused on individualised, collaborative, and preventative care.
We can no longer rely on simply “knowing everything”. Thanks to improved technology, recordkeeping and data analysis techniques, the rate of creation of knowledge within the medical industry has far outstripped our abilities to integrate it on a system level, let alone on the level of an individual clinician.
Guidelines can streamline decision making processes. However, they can only address the needs of a homogenised group of people. Guidelines cannot always take into account a patient’s personal, medical, social, and cultural histories.
AI (artificial intelligence) has the ability to parse unimaginable amounts of data in a fraction of the time a human would take. It can then identify information and research relevant to a patient’s demographics, previous history, and genomic data. AI can then predict success/failure rates, and risk/benefit ratio, of any given therapy for that patient. This frees the clinician to focus on educating and treating patients. Our tools will not remove the need for clinicians. It will help us make better decisions and tailor medicine to individuals.
We work in a system that perpetuates conflict between clinicians and encourages animosity towards our patients. A great registrar is a goalkeeper, blocking admissions to the cheers of clinical teams. We practice defensive medicine, requesting expensive tests because of "rectus protectus".
Effective collaboration reduces waste, while improving work conditions and quality of care at the same time. The solution lies at the intersection between culture and technology.
Medical school testing should better reflect a clinician’s real working conditions. Case-based projects, to be completed as a team with allied health students, are an ideal test format. Individuals each get a "piece of the puzzle", but the team as a whole must work together to solve problems.
Communication is vital to collaboration. When a patient is admitted to hospital, a "chat" should be created – it will be accessible to any clinician and allied health member involved in a patient’s care, and viewable by phone. Teams can then jointly discuss how to manage a patient. Pharmacists could identify medication issues or suggest cheaper alternatives. Nursing staff get a live feed on a patient’s management plan, and can escalate issues more quickly. Physiotherapy and OT could identify patients with falls or deconditioning risks and intervene early. If a patient needed a Cardiologist opinion, it would be as simple as adding them to the ‘chat’ and asking them a question, facilitating a live discussion. Investigation results could be pinged directly to each clinician, with Radiologists and Pathologists on standby to help choose suitable tests.
On the surface, there is very little sex appeal in disease prevention. It’s a slow process. The outcomes can take years, if not decades, before anyone benefits. It involves changing behaviour and culture. It is, however, our best strategy to maintain societal health while controlling runaway healthcare costs.
Community based preventative health teams are the way forward. Their charter would be to engage, educate and intervene early. Routine home visits allow health teams to engage with the public, dispensing individualised advice. People with chronic illnesses like diabetes can be monitored more closely, and issues like a slow healing ulcer treated before it becomes gangrenous. Teams can identify areas of high disease risk, then engage in targeted community campaigns to avoid crisis. Using AI and analytics, teams can predict potential disease outbreak areas and institute measures (such as insecticides to kill mosquito larvae) months before an epidemic occurs. Teams would engage with local government to design healthcare policy.
These teams could be run cheaply by healthcare students as part of training. By combining field work with political engagement, we would have a healthy society and bank balance too.
Some people fear our health crises are insurmountable. Others remain more optimistic. I, for one, believe a happy ending depends on both cultural and technological innovation. I believe the future of medicine is bright.