I was brooding on what to write as my entry to Apollo Hospital's " how can modern healthcare touch lives ? " competition since a long time. By this time i had consulted several people and gained much information and ideas but had no concrete subject to write an article on (This may be because i am from an engineering background ;) ). Then talking with my cousin sister who is a Doctor changed everything. She inspired me to write about what can be the next big thing in healthcare and this is what i came up withI.] Biggest Challenges :
Healthcare has transformed many a times since its inception from patient demography,medicines,physicians, technologies it really is an ever changing field. I realized a very important thing in all this, Rather than looking forward breathlessly to … how stem cells will be curing all sorts of ailments … what we should really be asking …how can we make quality healthcare more affordable ? By saying this I mean to state that with development in new technologies we should also be looking at implementation and affordability of the same.4 Major challenges which i believe are affecting healthcare in India today are :
1. Demographic shift : Patient to doctor ratio in India is becoming bad to worse day by day. Reducing the ratio further are the number of quality doctors and healthcare systems. This is a factor which is affecting us badly
2.Cheap Oil :We have to agree that end of cheap, readily available oil is at hand, probably before the end of the next decade. Health care, as it exists now, cannot function without cheap oil.Health care is entirely dependent upon cheap readily available oil not just to move patients to care, but in the production of supplies and drugs, to light and heat our buildings, cook our food, autoclave our instruments, launder our linens, and to support the society in which health care is embedded.
3.Climatic change patterns : The World Health Organization (WHO) anticipates that climate change will in turn change patterns of infectious disease, increase the incidence of weather-related disasters ,Effects on industry & will result in substantial economic costs for governments.
4.Quality healthcare at affordable price : Due to large socio-economic gap we need affordable pricing of quality healthcare. The rural-urban gap of healthcare facilities & availability of trained personnel has caused a big gaping hole This is believe is the biggest challenge in itself.
Look at these 4 challenges and you can see four separate categories of impact.The demographic shift increasing patient load & decreasing caregiver supply,Peak oil and other resource causing shortages, compromising patient mobility,day-to-day operations & significant financial consequences. Global warming will cause in the future long-term impacts on government finances, and hence will affect health-care budgets while rural-urban gap has already left a gaping big hole . Each of the pressures is independent of the others.This isn't a domino effect, where removing one chip stops the process.This is a perfect storm, where, even in the absence of one or two of these factors, it is going to get pretty darned windy.
II.] The Scenario in India:
So without abandoning advocacy and our passion to change the world, we should begin to visualize the changes implied by these powerful socio-economic forces.Currently, physician services start locally, in primary care centres and smaller communities, and are usually provided by family doctors. Larger health-care centres have more technology (labs, radiology, etc.), and increasing diversity of physician expertise, with the largest having significant access to educational and governmental administration.
Consequently, physician services in India today are enclosed within a rigid knowledge hierarchy. Patients are distributed, while the health-care system is centralized. Patients are mobile while the system is immobile, and waits for the patient to come to it. We foster a rigid view of the "medical expert," while under utilizing and under appreciating the local doctor. Interaction between doctors is very weak and generally involves only doctors who end up in the same room as the patient.
Yet, the forces discussed above mean that patient mobility is likely to decrease, perhaps dramatically, while numbers seeking care will increase in the presence of fewer trained caregivers. Local clinics will have to fill the gap, and patients will have to do more for themselves, while lineups to see specialists will get longer.In other words, whether we like it or not, we are moving from a centralized model to one in which health care is distributed.
III.] 'Distributed' healthcare : A possible solution ?
If the transition to a distributed health-care system is inevitable, we need to ask how to maximize such benefits while minimizing the risks. We need, in short, to get from here to there by the safest route.
For one thing, we need to begin now to enhance the role of peripheral generalists, and accelerate the development of more "clinical technicians." A perfect example can be that of a Nurse. Now,Nurses can't diagnose your pneumonia, or set and splint your broken arm, But in a defined role they have substantial expertise, and the profession is a good model for the future. Will we see the development of elder care workers with extended expertise in specific problems? Greater numbers of nurse practitioners? I think we will.
If patients aren't going to be as mobile and specialists less available, then the onus is on the local primary health-care system to provide, not transport, but information, and on the tertiary care centre to provide, not hands on care, but a workable management plan at a distance.
We will need to generate detailed knowledge about that patient locally which would mean committing the expensive, but appropriate investment in CT scanners and enhanced lab capabilities for small centers In many ways, the move to the distributed health-care model requires a blossoming of technology and health informatics in rural India.Imagine a emergency physician in a village like Chiplun filling the role of trauma team leader in Mumbai, for example, with communication occurring via video-conferencing, and the local team perhaps entirely composed of paramedics.This can really provide the essential quality help which can be cost effective
A major problem that can be handled by distributed healthcare is Quality care at the right time which can save lives. Imagine an individual with a catastrophic and evolving bleed inside the head which needs a hole drilled into the skull to release the blood. This is a terribly intimidating task, but is not that technically complicated. The tools required can be available in any emergency department, but the expertise and experience is often not. Could this procedure be done by a family physician in a distributed health-care system? I think so, if done with neurosurgeon support through a trusted technological pathway that was familiar through routine consultation.
We need to enhance and practice distance medicine, with local generalists of all types as partners. We cannot entertain an idea of a specialist working through some robot remotely as the expenses involved means this simply won't be part of our rural health care anytime soon. And why should it be when a nurse practitioner with infinitely greater capacity can be walked through the sub specialist's examination of a patient over video link.
Critically, we need to know to deliver the right education from the right teacher to the right learner. In many respects, this will be "just-in-time" teaching, and right now we aren't very good at that.We need to know how to teach effectively when both learner and teacher are under fire (e.g. drilling a hole ;) ). We need to be less shy about challenging the copious amounts of medical misinformation on the net and other media; we need to teach our population about evidence and risk more effectively. Information is being democratized; it will be a powerful force that shapes our health care and our society. Unfortunately misinformation will have many of the same properties.
Thus distributed can cope up with the major challenges the near future can throw at us but this kind of healthcare is a big change from our traditional ways of healthcare. Fighting for a big change is often unreasonable, particularly when that change connotes benefits as well as dangers. It seems more reasonable to try to shape change so that the opportunities can be realized, and risks ameliorated.
In an increasingly distributed society, should health care really try to buck the trend?
Written as a competition entry for Apollo hospital's " how can modern healthcare touch lives ? " competition.
If you want to find what new technologies and trends are in todays Modern Healthcare services then do visit:
http://www.apollohospitals.com/cutting-edge.php
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