The Future of Medicine
“These people understand that home
may be where the heart is but it’s not currently where
the health is,” says Magee. “Just as General
Electric revolutionized toasters and refrigerators, and
literally did improve the quality of our lives, GE and these
other technology firms now realize that the same can be done
with home health technologies, especially if you leverage them
with Wi-Max and other wireless technologies and transmit
information automatically to one’s care team in support
of that home-health team feedback loop.”
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Trends or Myths?
As if the mega-trends of
aging, consumerism, and technology are not enough
for young doctors to worry about, medical experts
offer a broad range of trends that might affect
physician practices in the coming decades. Here is
a sampling of others, along with some that may be
more hype than fact.
• Physician shortages:
Predicted for years, physician
shortages are a debatable issue. Because our
country is a free-market system, there will always
be shortages in specific areas or specialties,
since some physicians don’t want to go into
certain practice environments. “There is a
perception now that there is going to be a shortage
of doctors. I believe that is only a
perception,” says John Hopkins researcher
Jonathan Weiner, MD, a professor of health policy
and management. “This is largely promulgated
by medical school deans and national search firms,
and begrudgingly the Feds, who like the notion of a
shortage rather than a surplus.”
• Broken Payer System:
Few argue that the
current private payer system is archaic. According
to Jordan J. Cohen, MD, the immediate
past-president of the Association of American
Medical Colleges, health care is fast becoming
unaffordable for patients. On the physician side,
demands for increased accountability, lower fees,
and more paperwork are choking the system in
bureaucracy. The failing system is a trend that
must be addressed within the next decade.
• Medical Ethics:
In a consumer-driven society,
pressures will increase for physicians to cater to
the vanity whims of health consumers, especially
those paying their own freight outside the
traditional third-party payer system. Plastic
surgery interventions currently lead the ethics
debate, but close on its heels is biomedical
intervention for fetuses, neonates, and young
children. Anti-aging regimes are already on the
scene and will increase markedly in the decades to
come, fertile ground for ethical conundrums.
Pandemics: The current
health-care system in this country is already taxed
to the breaking point, but some researchers see the
increasing likelihood of global pandemics finally
breaking the system. The demands on doctors and
health-care systems will be far more than they can
handle in the case of even a modest pandemic. The
1918-19 influenza pandemic killed as many as 100
million. Many epidemiologists believe that number
will pale in comparison to a new pandemic hitting
the overcrowded and impoverished third world. And,
medically underserved areas of this country will
not be immune to devastating health consequences,
both to patients and the caregiver system.
• Sleeplessness,
Depression:
In our incredibly fast-paced
nation, sleep is the first necessity to be
sacrificed at the altar of productivity. Since the
dawn of the 19th century, the average sleep for
Americans has dropped to under seven hours from
nine. For those not already suffering depression
from genetic and environmental causes,
sleeplessness markedly increases the chances of
clinical depression. The human organism is simply
not made for extended periods of sleeplessness, a
fact that physicians will need to grapple with-and
treat-for the foreseeable future.”
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The majority of content on the Internet
is health-related, according to Google, which reports that 80
percent of adult Internet users have searched for
health-related topics. Google and other search companies
recognize that the major contribution they can make to a
preventive health-care system is to allow the real-time
infusion of exactly the right type of knowledge to support
patients and caretakers in joint decision-making. The systems
they are already developing are the systems that will
eventually bring the people closer to those caring for them.
“The true promise of information
technologies and new media,” says Magee, “is to
strengthen the patient-physician relationship and to cement the
commitment and confidence and trust that the people have with
their health-care providers.”
Health care in 2030
Given these mega-trends, what will the
practice of medicine look like in 20 or 30 years? Brace
yourself.
The scenario described at the beginning
of this article, that of Maria and her daughter Ellena, will be
just the starting point for the radical transformation of
medical practice, if Magee and his futurist colleagues are
correct in their projections.
Front and center will be that traditional
medicine will be turned on its head. The home will become
“health central,” with its winning combination of
24/7 care, multi-generational connections and sophisticated
technology that will allow robust, real-time data inputs
transmitted to the physician-led, nurse-directed health team.
That, in turn, will enable the team to prescribe daily,
age-specific, micro-adjustments in the patient’s health
plan that will markedly improve quality of life. Computer
programs using embedded, research-based treatment protocols,
best practices, and prevention strategies will aid the
health-care teams.
Health insurance will be nearly
universal, with insurance premiums decreasing in those homes
where the family member responsible for home health
care—the home health manager—demonstrates positive
health outcomes for the family. Nursing homes will be a relic
of the past. Homes will be outfitted to maximize caring for a
senior with mild dementia or other chronic diseases. Basic
diagnostic tools and therapeutic treatments will be supervised
at home by the home health manager. Data will flow to the
physician-led, nurse-directed team and feedback then provided
to the home health manager. With this new paradigm, people like
Maria will have services layered on pro-actively, because
doctors and nurses will be able to see her decline in real
time. She has a good chance of living a high quality life and
dying at home without ever having felt isolated.
Nor will the informal home health manager
feel isolated. She will be directly supported not only by the
nurse on her team, but by Internet communities devoted to
providing detailed information and real-time support to those
facing the challenges of specific chronic diseases. The care
team will understand that the fears of the informal caregiver
have to be managed at the same time as that of the patient.
That sense of high-tech touch will be one measure of real
progress.
By 2035, people younger than 20 will have
had the benefit of a Lifespan Management Plan since well before
conception, as their parents prepared themselves for the rigors
and joys of childbirth and childrearing. By birth they will
have been the beneficiaries of advanced lifecycle planning that
will maximize nutrition, exercise, diagnostics, and medicine.
Throughout their lives, they will benefit from research that
will allow them to micro-adjust their lifespan management plans
to maximize their quality of life.
How expensive will this new health-care
system be? Right now, with our broken health-care system,
approximately 16 percent of our gross domestic product (GDP)
goes to health care and nearly every segment of our society is
up in arms over its high cost. But, as Magee and others point
out, no one knows how much the American consumer would spend
for a health-care system that actually worked—that
markedly improved one’s quality of life and even extended
it. Some economists believe that 25 percent of GDP would be
acceptable. And, a prevention-focused, home-based system
financed by a combination of government and private industry
might be cheaper than our existing system.
And, how will the physicians fare as they
dispense medical care amidst this whirling dervish of change?
Under this new vision, the typical physician will be able to
grow office capacity, since most care will not involve a
patient visit. Reimbursement will be reconfigured to reflect
the physician’s evolved role in managing teams,
spearheading education and prevention efforts, and dealing with
the complex challenges of multigenerational health. A new brand
of nurses, drawn to the field due to its redefinition as an
integral member of the care team, will make the
physician’s job easier.
And the outcomes of this futuristic
vision? “Family nutrition is carefully planned and
executed,” predicts Magee. “Activity levels of all
five generations are up, weight is down, cognition is up, and
mental and physical well-being are also up.”
Medical futurists believe that most
physicians and patients, if given proper incentives, will
thoroughly embrace the kind of joint decision-making that is
supported by constant data inputs.
“I foresee a golden era of joint
decision-making that is just around the corner,” says
Magee. “But in order to get there, we have to very
deliberately embrace a new vision and build out a system that
is re-centered around an electronic loop that goes from home to
care team and back to home. To do this we have to access both
health-system and information-system expertise, with the
involvement and resources of the financial, technology,
entertainment, and health industries.”
Despite mind-boggling discoveries and
rapid technological advances, the day-to-day practice of
medicine has changed surprisingly little in more than 100
years. That, most assuredly, is about to change profoundly.
Les Picker is a regular contributor to
Unique Opportunities.
