How healthcare became sick-care and what can be done about it
A doctor in Massachusetts was treating a woman in her 80s for indigestion. When the doctor asked what medications she was on, she revealed a plastic grocery bag full of drugs. “I do not know what I take, but I take all these,” she said, her whole body quivering. There might have been about twenty drugs in the bag – a few from each of the specialists she must have been visiting.
If one closely observes the medical operations in many parts of the world, it becomes clear that an industry whose primary concern has become that of sick-care, but not of healthcare. The healthcare business proposition fails to remain exciting when we become its customer. It is then that we realise that we are stuck in self-defeating quicksand where we are not confident enough to entrust our bodies to a system and expect to be fixed. Trust amongst patients and their providers is at its lowest in almost every part of the world.
Despite concerns, we seem to have taken to sick-care well as a society. Most patients are happy to absolve the responsibility of staying healthy when an entire industry promises to find a fix for all evils. Bizarrely, our industry is fuelled by patients who continue to smoke, eat without thinking and lead sedentary lives, but expect to be taken care of when they fall sick. It is whom doctors routinely see after spending a decade or more in pursuing medical education.
Healthcare, get your mojo back
Every time a patient seeks care, there is 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 is 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 other patients like her through her data? Certain conditions require fixing, but there are several others that require healing. For example, a broken hand needs fixing but hypertension needs long-term healing. Chronic conditions, which seem to plague the society are managed better through lifestyle changes than medications alone..
Changes are needed in the healthcare policy that supports an ecosystem in keeping its population healthy and not just fixing 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 move away from our dependence on patient volumes.
Technology is key in reversing how to change the focus from sickness to health. Till now, technology was used as a means to complete the billing, conduct clinical examinations or store medical records. But, there is a need to go use technology to connect the dots that influence our health. Through environmental information, an asthma patient could be forewarned about ‘asthma hotspots’; that he or she traverses during a commute. Devices that prompt us to breathe when our heart rate goes up might help us manage stress. Diabetes can be better controlled when we see a continuous graph ofglucose 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.
Getriatric 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 utilise drones routinely as a part of emergency medicine. 3D printing could improve compliance by making patients “touch and hold” their diseased organs.
Hospital in a mall
A woman wanted to replace the cast on her broken hand and visited what could be called a new age hospital in the Delhi metropolitan area. She was welcomed by a gloved doorman who seemed to belong to a St. Regis than to a local hospital. Being a holiday, the outpatient area was closed but she found signs to a multiplex movie hall and “retail therapy” to relax caregivers, lest they tire of caring for their sick! The biggest surprise was waiting in the emergency area, neither was the hospital equipped to cut open the cast nor did it have doctors on call to render care. But they had a spa!
Preventing patients from falling sick sounds utopian but converting a hospital into a mall is not what is needed. The hospital-mall demonstrates that it’s not resources that is lacking, but the mindset to channel the means towards keeping people healthy. For its own sake, the medical industry needs to wake up and get its mojo back.