Tag: Medicine

21 Jul 2016

How To Cure Healthcare from its own terrible sickness

During one summer in the southeast of US, I shadowed a doctor who was treating an obese woman in her early 50s. She was out from a colonoscopy that also involved removing a piece of chicken that was stuck in her gut. Such a procedure costs $1,185 on an average depending on where you get it done – money that she or her employer or the taxpayer has to bear because she never learnt to chew her food sufficiently and not gulp it down while watching TV.

Having closely observed medical operations in many parts of the world, I see an industry whose primary concern has become that of sick-care and not of healthcare. But the healthcare business proposition fails to remain exciting when we ourselves become its customer. It is then that we realize that we are stuck in self-defeating quicksand that doesn’t give us the confidence to entrust our bodies to the system and expect to be fixed. Trust amongst patients and their providers is at its lowest in almost every part of the world.

Despite our concerns, we seem to have taken to sick-care well as a society. Most patients are happy absolving the responsibility of staying healthy when an entire industry promises to find a fix for all evils.

Bizarrely, it’s the patient with a piece of stuck chicken that fuels our industry. It’s she whom doctors routinely see after spending a decade or more in pursuing medical education. It’s she who chokes our tertiary care system because she checks in too late. From the imaging equipment needed to see her gut to insurance that covers her procedures to a legal trade that encourages her to blame the undissolved chicken, we depend on her to gulp her food down so that she can continue being our customer.

Healthcare, get your mojo back

Every time a patient seeks care, we have an opportunity to change how we function as an industry. Instead of merely prescribing a fix, we can begin by asking questions that take us deeper into the process of care. Is her environment causing her to fall sick? What’s her genetic data indicating? What does her microbiome reveal about her gut? What role does stress play in her condition? How can she be educated to help herself? How do you reach more patients using her data?

Surely certain conditions require fixing but there are several others that require healing. For example, a broken hand needs fixing but hypertension takes better to longterm healing. Chronic conditions, which seem to be the plague of our times, are managed better through lifestyle changes than through medications alone.

We need changes in healthcare policy to support an ecosystem that keeps its population healthy and not just fixes the sick. An industry that gets paid based on medical transactions cannot be expected to reduce those encounters. When we flip the equation to make hospitals into control-towers that track disease before people fall sick, we begin to depend less on patient volumes.

Technology is key in reversing how we change our focus from sickness to health. Until now, we’ve used technology as a means to complete our billing, conduct clinical examinations or store medical records. But we need to go further by using technology to connect the dots that influence our health.

Through environmental information, a patient could be forewarned about “asthma hotspots” that she traverses during a commute. Devices that prompt us to breathe when our heart rate goes up might help us manage stress as it occurs. Diabetes can be better controlled when we see a continuous graph of glucose levels captured through sensors. Electronic health records could become pathways that connect patients to doctors remotely, extending access to care at the time of need. A zip code map of patients whose vital signs are out of line could help providers address symptoms even as they manifest. Elderly care can be monitored through homes with sensors that track movement. Smartphone-based lab tests can control early conditions of heart disease through primary care rather than expensive specialized care. We could utilize drones routinely as a part of emergency medicine. 3D printing could change how patients understand their condition by touching and holding diseased organs.

The technology we need to nurture an industry that improves health is already here. All we need is imagination.

 

Praveen Suthrum is co-founder and President of NextServices, a healthcare technology and management company with offices in Ann Arbor, Michigan and Mumbai, India. Not coincidentally, he is a passionate alumni of the University of Michigan Ross School of Business.

( This article was also featured in LinkedIn Pulse Healthcare)

03 May 2016

Rethinking healthcare [A simplified approach to care]

Before the invention of the stethoscope, doctors routinely laid their ears on chests of patients to check how they were doing. Homemade concoctions, essentially placebos, often made people feel better. Doctors visited homes of patients who would later pay them whatever they could afford. Local apothecaries sold morphine, a derivative of opium, to reduce pain. Medicine for its part was a nascent science – most of today’s diseases were yet to be discovered.

Fast forward to today, healthcare is a multi-trillion dollar industry. Medicine has branched into 120 recognized specialties and subspecialties, spinning out several industries like pharma, biotechnology, medical devices and so on with billions of drugs prescribed and lab tests performed every year. Medicine is no longer within the domain of the doctor and patient – it’s a science with ever increasing complexity.

While this advancement has helped in doubling our life expectancy in the last 100 years, the complexity of our healthcare system is hurting more than helping.

The demand for specialists is so high that they are unable to invest the time required to identify or address the root cause of why the patient has fallen sick, which could depend on factors such as the environment where she lives. Further, the patient is prescribed drugs that often have interactions with those prescribed by some other specialist, inadvertently making patients sicker. In a world of quick everything, neither the doctor nor the patient is able to go beyond fixing the problem at hand.

It’s difficult to keep solving underlying problems of sickness when the industry is paid based on the quantity of care delivered. A doctor gets paid more if he performs more procedures or sees more patients, not if he keeps a thousand people healthy. Most patients today would leave a doctor’s office dissatisfied if they aren’t prescribed a drug or made to go through a lab examination. The result is a business that wants to make a patient feel better for the short-term by doing something because that’s what the customer appreciates.

At an earlier time, patients visited doctors to fix conditions that were gross and obvious like broken hands. But now our expectations have changed. We want everything fixed so that we don’t have to compromise on our desires whatever those may be. But the more we understand the workings of our body, the more we discover how little we know. The quick-fix approach to medicine fails badly because we are trying to fix a constantly evolving target – our body.

While we spend billions of dollars on human genetics, we hardly know much about our microbiome or the genome of our bacteria. Only recently we learnt that 90% of our cells is microbial and only 10% is human. That’s 100 trillion microbial cells that we know very little about. Moreover, they are changing all the time based on where we live and what we eat. How can you then target and control what they are doing or not doing?

Health can be better influenced than fixed. There are four factors that cause disease: the patient’s inheritance, environment, physical capacity and psychological state. We don’t tend to catch a cold when we exercise regularly. Our bowel movements are easy when we eat freshly cooked vegetables. We also know that we suffer body aches or fevers when we are stressed. Our body’s inherent tendency is to stay healthy unless disrupted by the above factors.

I spent 20 years as a hypertensive patient popping a pill, only to discover now that my condition is reversing itself through better lifestyle and habits. While I proactively seek doctors and labs to help me track progress of my condition, I don’t use them to find a quick fix so that I can go back to lying on the couch watching TV with a pizza and drink.

As a society, we need to reflect on our mere pursuit of human longevity by using every medical means possible. The healthcare industry needs to rethink its role and simplify its approach to care. The older role entailed waiting for the patient to arrive and fixing problems based on her complaints. When we reverse those lens, the role might mean identifying precursors to problems and helping people maintain their health before they fall sick. It’s time we think about healthcare differently.

Praveen Suthrum is co-founder and President of NextServices, a healthcare technology and management company with offices in Ann Arbor, Michigan and Mumbai, India. Not coincidentally, he is a passionate alumni of the University of Michigan Ross School of Business.

( This article was also published by The Economic Times and featured in LinkedIn Pulse Healthcare)

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