The fundamental structures of our current healthcare systems are still very much rooted in their century-old design, with most of the providers operating in their own “box”. Rarely is there a “wholistic” approach of the patient’s needs.
PCPs in the US and GPs in Europe are responsible for providing a first level of care to patients. As soon as the patient requires care beyond what the “Gatekeeper” can provide, a specialist will take over. To ensure that his primary care patient is comfortable with the recommendations of the specialist, the “Gatekeeper” need to spend time communicating with and question the specialist and, then, get back to the patient. This doesn’t happen frequently enough, as, for example, one can see patients being prescribed 15 or 20 different drugs to be taken every day! And, what about recommending a “second opinion” for any important medical decisions?
Fewer and fewer doctors, especially the specialists, are independent and are increasingly attached to medical centers, hospitals, now more than often ultimately owned by financial groups!
Technology and medical research are source of new drugs, vaccines, machines, “imagery”, testing methods, even “body parts”, etc. and their development is accelerating in many areas, like AI or upcoming “cross-species organ transplants”. This is very promising to improve care..
In the past 50 years, layers upon layers of computer technology and internet services have been added “for increased efficiency and cost reduction”. The internet was touted as the solution to provide a better “service to the patient”. Has it? Many people who feel trapped in the system don’t even dare asking questions, some afraid of being penalized and denied care.
For both, patients and doctors, the situation will be getting worse as “AI-based” systems are rapidly changing the landscape. Healthcare providers, who have limited understanding of those systems, are likely to be obliged to use those tools without much oversight.
The main issue that healthcare providers will raise to a better communication with their patients is that most of them do not provide them with information that is usually reliable enough to establish a diagnosis or make a decision for a treatment.
Beyond this reality lies also the fact that we are still in a world where interoperability of healthcare systems is still limited. To quote a recent study: “The lack of interoperability between health information systems reduces the quality of care provided to patients and wastes resources.”
This is even more problematic in the case of rare diseases and difficult cases where tests may be carried out, and their results are often not easily accessible.
Also, must be taken into account the power of laboratories and pharmaceutical groups to prevent clear communications to the public about the effects (even when they have been identified and measured) on patients of drugs they produce.
Worldwide, in most public or private healthcare systems, doctors and nurses rely upon a revenue, which is getting increasingly lower in real economic terms. As a result, significant numbers of them are quitting their jobs and even discourage the next generation to follow their path. Longer term, this situation will translate into lower competence of healthcare providers.
As it is demonstrated by studies supporting the concept of “patient-centered care”, cheaper care may also be better care. However, these studies do not assume that healthcare providers may be becoming less competent.
In parallel, we see an emerging trend to channel patient-doctor interactions towards “tele-health” sessions, that insurance systems promote to offer faster service while reducing growing costs. Such sessions would probably be more beneficial to the patients, if they would know what are the “right questions” to ask.
Additionally, in countries, like the US, where healthcare is profit driven and lawyers “run the show”, the legal cost of an error can also influence “providers” into making decisions that will keep them “safe” or will minimize their administrative work, however not necessarily to the benefit of the patient.
For the time being, we still primarily consult with human doctors who are responsible for diagnosing a patient’s illness and prescribe a treatment (drug, surgery, etc). Hopefully, there are still some compassionate doctors for whom the “Hippocratic oath” has still a real meaning and will take the time and make the effort, including talking to colleagues, to find the best ways to improve the health of their patients.
However, we also meet doctors who “do everything by the book” and could most likely be replaced by “robots” with the arrival of AI-based tools. For the patients, it has become more important than ever to be an integral part of the processes that will determine and implement the best course of action for their health.
If you think you should have or contribute to better dialogues between patients and their healthcare providers, this web site is for you.
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