Health Care 2040

Making Our Health Care System More Like Doctor Shows

January 25th, 2017

For the past few months I have been coping with chronic back pain and muscle contractions, which have taken their toll on me physically and emotionally. I have been largely incapacitated, often reaching out to the rest of the world via Skype and email, and having to continually negotiate through the USC medical system, which has taught me more than I wanted to know about how even very good health care providers routinely under-serve even the most privileged populations of patients, leave aside the quality of American health care as experienced by those who lack access to wealth, power, and resources.

The patient finds herself constantly jockeying for the attention of doctors, who listen only enough to find the trigger words that push them to the pre-scripted solutions to predictable problems. The system strives to be efficient in getting patients in and out of the offices; it strives to lower risks and liabilities, but it has not been optimized to identify and solve complex problems having to do with the emotional and physical lives of their patients. Patients learn to speak faster and faster, trying to provide a fuller context, trying to make sure they say the trigger words that allows their pain and suffering to be taken seriously. Despite access to sophisticated information management tools, the doctor scarcely recalls the patient from one visit to the next and thus the same basic questions need to be asked and answered again and again, squeezing out anything but the most surface data about the issues. Records are imperfectly transferred between health care providers. And there seems to be no incentive for anyone to pursue questions between visits, to seek out new data which might link a particular patient’s experiences to larger patterns, to check in on patients who are not actively tugging at their pant legs, or to check to insure recommended follow-up visits get scheduled.

All of this contrasts sharply with the way the health care system is portrayed in popular media. I’ve been watching a new television series, Pure Genius, which represents an idealized medical facility where the world’s top doctors and top engineers work together to insure that they meet the needs of their patients, money is no object, and in the process, the Bunker Hill doctors stretch the limits of current medical technologies and practices. There’s lots of cool stuff going on here in terms of medical databases and self-monitoring technologies and 3d printing and genomes and… But we don’t have to go that high tech or that contemporary: the health care drama continually reminds us of the links between the medical issues a patient confronts and the social/emotional contexts of their lives. The doctors are constantly searching throughout each episode to identify and respond to problems that seem elusive; they often reach medical breakthroughs by getting some new insight into who their patients are; and they are seen talking across specialities about their patients even when they are not sitting there in the room demanding their attention.

Screenshot from Pure Genius

To me, it is this mind-set, this mix of curiosity and empathy, this collective intelligence and team work, which we would need to see as the core values of American health care in 2040. Sure, the tech is nice, don’t get me wrong, but the point of the show is that these tools and processes will always be high-end. But what would it take for curiosity and empathy to be the new norms for all healthcare professionals? Would it require us to establish a class of people in the system who are assigned as advocates for patients, who go with them across all of the various parts of the system, keeping track of the whole patterns in their lives, insuring that their needs are met? Would it require some kinds of incentives for doctors not just to treat problems but to identify their causes and even better to deploy preventive medicine to respond to potential medical issues before they disrupt the patients’ lives? Would it require a different, less hierarchical and bureaucratic structure in favor of more fluid ad hoc structures where doctors work together around specific patients and problems, a key theme running through Pure Genius?

Recommendations

Providing health care access at low cost to all Americans should be the minimal rather than maximum expectation.

Once health care is guaranteed, the shift should be towards defining what qualities we expect from American health care. The goal should be a more holistic and patient-centered approach, one which encourages doctors to be more empathic, creative, and curious in how they approach medical questions. Clearly developing these skills starts with medical schools and perhaps before in how we recruit potential doctors and nurses.

Patients need to be provided with case-workers/advocates who help them navigate through the health care system, insuring they access the best doctors and specialists for their needs, making sure they do not fall through the cracks at any point in the process. These advocates should be assigned to the patient, not serve the interests of the insurance company, and so they should be about maximizing health benefits.

There should be greater collaborations between specialists and doctors so that they pool knowledge and consult regularly about the challenging aspects of cases, so we can follow developments that fall at the borderline between areas of focus rather than dismiss symptoms that do not fit squarely into any one area.

Health care records systems need to be upgraded to insure easier sharing across different doctors and medical facilities, something easier said than done as suggested by the analysis of this problem provided by Robert Wachter’s The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age (New York: McGraw-Hill, 2015).

Henry Jenkins is the Provost’s Professor of Communication, Journalism, Cinematic Art and Education at USC.