• Editorial - The Future of Health Care Delivery

    Letter From the Editor

    You and I have witnessed remarkable changes in health care delivery during our lifetimes.

    I suspect we can all remember back when we were quite young and had a stomach ache or fever (or something worse) and the good family doctor would come to see us at the bedside, sometimes in the middle of the night.

    Of course, with the exception of those group practices that advertise as “Doctors Making House Calls,” that era of health care delivery by house call is long gone. By the time our era came along, health care was delivered primarily in our clinics or in the emergency room or hospital. But we were still caring for our patients face-to-face. In the future era, soon to follow ours, even those doctor-patient encounters may be looked back upon with nostalgia.

    For those of you who have not yet seen it, the January 2019 issue of National Geographic is devoted to “The Future of Medicine” and has several interesting articles about what may be coming in health care delivery. It seems very futuristic and yet may be just around the corner.

    In one article, Dr. Daniel Kraft, who practices in Northern California, predicts that “increasingly, care will be delivered in a blended real-world-mixed-with-virtual-world model.” He suggests that the majority of patient-doctor interactions will no longer require the “laying on of hands” or even a physical exam. So, what will the future look like?

    A variety of devices are currently in development that may one day be used to obtain our vital signs and other important medical information. For example, of particular interest to the ophthalmologist, “smart contact lenses” are now in development that may someday measure blood sugar values in tears, to help diabetics manage their diet and medications, or may even pick up early indicators of cancer or other conditions.

    Mobile vital sign tracking at a level that was once found only in intensive care units, may one day be a standard part of health information acquisition. Already, health tracking devices such as Fitbit and Apple smart watches are commonly used to measure and document fitness activities. In the future, they may be central to detection, treatment and, most importantly, prevention of disease.

    For example, flexible electronic medical tattoos and stick-on sensors are being developed that can obtain electrocardiograms, measure respiratory rate or check blood sugar and transmit the results seamlessly via Bluetooth.

    So, who will receive and process all this information? Some may be shared with the physician via web-integrated wireless scales, blood pressure cuffs and monitoring devices. Patient-physician interactions my take place through web-based portals with Skype-like techniques. A new type of physician, the “virtualist,” may save patients the travel and waiting room time and actually return us to the days of “visits” by the doctor in our own home.

    Or could it someday be a robot that will replace the human provider in answering information and triaging calls? A “chatbot nurse” may try to learn what ails you by asking about your symptoms and tapping into data from your wearable devices. Also, in the future are “digiceuticals,” in which prescribed software is used to enhance well-being, such as monitoring blood pressure and other factors to help manage patients with heart failure.

    Of course, artificial intelligence will take an increasingly important role in the future of health care delivery. Already, AI is being trained to read tissue samples and radiologic scans, with results that are comparable and much faster than those achieved by physicians. But it is not just the pathologist and radiologist whose future may be in jeopardy. Algorithms have been created for retinal scans that can predict which patients have systemic hypertension or are at increased risk of heart attack or stroke.

    Like me, many of you reading this may think that you are thankful that you won’t be faced with the challenges of this new era of health care delivery. Things are complicated enough today. It is certainly true that this “brave new world” will require both health care providers and patients who are facile with advanced electronic technology.

    But keep in mind that both the doctors and patients of the future will be those people who have grown up on these technologies. And you and I can just be grateful that we have been a part of this continuum in the evolution of health care and that we were privileged to see what it was like before our era and to have a glimpse at what the future may hold.