Healthcare innovation is everywhere. Telehealth will make virtual care actual. Direct Primary Care (DPC) will get rid of the pernicious influences of fee-for-service and health insurers. Precision medicine will make our care so...precise. Virtual reality (VR) will be an important part of our health reality. And artificial intelligence (AI) will help doctors deliver better care.
Truly, it is an exciting time to be in healthcare. But when I read about all these great ideas, I can't help but think about the Ptolemaic system.
The trouble was that, as observations and predictions both got better, they didn't agree. That forced several "fudges" to the theory, such as epicycles, eccentric motions, and equants. Anything to preserve those "obvious" assumptions. The Copernican revolution -- which took some 1500 years after Ptolemy to happen -- finally asserted that, no, the earth is not the center of the universe, and, oh-by-the-way, things move in elliptical orbits, not circles.
Healthcare has not had its Copernican revolution yet. We're still designing more intricate epicycles.
Almost all of those exciting innovations being discussed start with an "obvious" assumption: the doctor-patient relationship. We can debate whether our system could or should be "patient-centered," but that's just another epicycle.
We keep reading about "Uber for healthcare." It's about helping get patients to their appointments! It's about getting doctors to patients, on demand! It's about Amazon sending our prescriptions in drones!
No, it's none of those. Those are more epicycles. As I wrote a couple years ago, Uber for Health Care Won't Play Nice. Let me explain why.
Most health care innovations are as if Uber tried to help people find taxi drivers, or pick a taxicab, or see in advance how much the fare would be. Or if AirBnB helped people research and book hotel rooms.
Uber and AirBnB didn't care about the traditional taxi or hotel industries. They didn't care what regulations those industries had to follow. They said, hey, you want to get/stay somewhere; we know people who are interested in helping you with that. We can connect you to those people.
"Those people" weren't licensed taxi drivers driving licensed taxicabs operating under city-approved rates. They weren't licensed hotels. They were just people who could help you get or stay somewhere.
Maybe Uber, AirBnB, did go a little too far in avoiding regulations. That pendulum is swinging back (one suspects as much interest from governmental bodies in getting some tax/licensing revenue as in consumer safety), but it's not going all the way back to where the taxi and hotel industries were. The genie is out of the bottle.
That will happen in healthcare too. Someone will figure out a way to avoid some or all of the crazy-quilt of healthcare licensing and regulatory requirements.
You've got a health issue or concern; there is someone, somewhere, who can help you with it. Perhaps it will be a doctor or other healthcare professional; perhaps not. Whoever it is, they'll need to convince you of their expertise and how they've helped others with your issue. You'll have to decide who and how to choose.
That's "Uber for health."
This will drive physicians crazy. This will make many of us quite nervous. This will have the legislators, regulators, and licensing agencies scrambling to figure out how to stop it. All of which begs the obvious question: why do we not have that kind of ability now?
Don't think it can happen? It is already happening. People have been importing prescription drugs from other countries for years. It's not legal and it may not always be as safe as buying them here, but it sure can be cheaper. And if you think there is no peer-to-peer prescription trading going on, you're kidding yourself.
It is going beyond those examples. We've got people doing DIY for artificial pancreas. There's already a movement in Sweden to microchip yourself, right now to not need ID cards or key cards, but with the promise to eventually do far more. The New York Times just covered Grindfest, an annual meeting of biohackers. Some of the hacks the article discussed sound, well, pretty out there, but we're going to see more of this.
We're already starting to see DIY gene editing, as they also reported on. What next?
If nothing else, it would be nice to own your own health records -- all of them -- and be able to share them with whomever you wanted, wherever they are, in order to get their advice and suggested course of treatment. Even if they live in another country...or another state, or even city. We can't do that now. It's crazy -- and it is not going to last.
Let's be clear on one thing: all of us need, or will need, physicians at some point(s). They're not going away, nor should they. Sometimes things do go wrong, and we need their help.
But let's be clear about this too: most of us do not need physicians most of the time. Physicians can help us stay healthy, but it is not clear that they can uniquely do so.
Unfortunately, we have a healthcare system -- or, more accurately, a medical care system -- that assumes that we always need physicians. That is an assumption we need to challenge.
Look, I'm not saying this kind of approach will work. I'm not even saying it is a good idea. I'm just saying that -- like it or not, ready or not -- someone is going to try it.
If we really want innovation, if we really want to improve things, we have to be willing to question our assumptions. All of them.
Just ask Ptolemy.
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