"The relationship between doctors and patients will surely be much more equal; indeed, health will be the business primarily of patients, with doctor as advisers, guides, and facilitators. Much of medial practice will be conduced online, with online consultations routine." -Richard Smith, BMJ
Chapter 15 is supposed to be the Ode to Joy of #PWSYN. The final chapter of how the patient (or consumer) will eventually break free from the shackles of the modern healthcare goliath. However, the chapter is more about a vision that is hampered by multiple roadblocks that might prove too much to overcome. Especially in the US where the employer based insurance among other issues will prove difficult for this transition to occur. It is clear that the digital revolution has set the stage for a seismic shift in how the patient will interact with their own "medical data" and the medical institution at large.
What you first need to realize about physicians and the medical community in general is that it is steeped with a history of skepticism. Sometimes this is healthy and other times it is not. This is pointed out early in the chapter where Topol points to the initial pushback to the use of the stethoscope, the fetal ultrasound, and even Hand Washing. So, it is not a surprise that it might take some time to fully embrace the emancipated patient (or consumer).
Topol uses the analogy of the driverless car to describe the emancipated patient (or the doctorless patient). However, he does point out that in many instances this is not completely possible-- for example, surgery. However, examples do exist where patients can gather data and act upon it with "consultation" from a physician or other health professional. Think about blood pressure control. Will it be possible to accurately measure one's blood pressure, titrate BP meds, motivate oneself to lose weight and exercise with minimal interaction with with medical community? This might be possible-- but will take motivated and savvy patient to do so. I can envision that drug side effects will need to be monitored--so, ensuring some interaction with the medical community will be vital. Other examples he mentions is strep throat in children and muscle movement and tremor in parkinson disease, among others.
Topol is very clear that in order for the emancipated patient to succeed (or even start) this must come from a bottom up, or grass roots approach. Not the current model of top down or government imposed. He included this video entitled power of one. In essence, if the data of each individual is available in high definition this might be able to help inform population health. So called, reverse epidemiology.
So, how exactly do we get to the emancipated patient?
Topol gives the example of the iMedicine Galaxy. Imagine a spiral galaxy with rings of interdependent forces that together will achieve something greater. In this case the emancipated patient.
What are these forces.
- Large employers
- Doctors and the medical community
- Data scientists
- Health insurers
In the end, each of these forces will need to embrace data so that the emancipated patient can emerge. The end result might look completely different from what we currently envision. However, to me it is clear that we need to find ways to embrace technology to allow for patients to take back their data and integrate into the medical infrastructure. That means, study, refine, and reassess how we interact with data. I can imagine a scenario where a patient's data is reviewed on regular intervals to assess response to therapy and augment that therapy. How long will it take for the emancipated consumer to emerge?
Will this be like the stethoscope? Once derided and now ubiquitous. Or will we remain skeptical?
Matt Sparks @Nephro_Sparks