It is difficult to pinpoint the beginning of the medical practice, in regards to the relationship between medicine, society, and technology. One could begin with the first classical physicians, Hippocrates (ca. 460 BC– 379 BC) and Galen (ca. 129 AD–216 AD). [1] In the history of medicine, Galen is regarded as the “father of the practitioner”. [1] He had an abundance of anatomical knowledge but was also known for performing difficult surgical operations, including the first brain surgery. [1] Until the eighteen-century, Hippocrates’s and Galen’s ideas and notes were regarded as the basis for medical knowledge. [1]
Another milestone in medicine could be traced to the nineteenth century, when science was combined with the industrialization of the modern world, and technology came into the forefront with the emergence of electricity. Other milestones include the discovery of penicillin or the groundbreaking discovery of DNA. All of these discoveries have improved the role of medicine in today’s society. Over the last 50 years, we have accomplished more towards the field of science, particularly in medicine, than we have in the last 200 years.
The mapping of the Human Genome was one of the greatest advancements in medicine and fostered a new focus in modern medicine – personalized and customized treatments. All of these advances have one thing in common – the emergence of technology. In today’s ever-evolving world, the role of medicine is more important then ever. The world is closely connected; diseases travel faster than we can assess them, however simultaneously information travels quicker. With the emergence of new technology, the advancement of medicine is increasing at an unprecedented rate, and in turn improving the quality of care while reducing the overall cost.
Before a medical device or a drug can enter the market, there are strict rules and regulations that must be met. Prior to passed government regulations, adequate research must be completed in order to determine whether the product is viable in the industry. In the area of pharmaceuticals, thousands of compounds are identified, before one reaches the development stage. Furthermore, hundreds of medical devices are developed before one is produced for commercial use. The advancements that occur in the medical field are possible because of the numerous research grants that are funded by both the government and private entities.
Over the last several years, scientific research and technological development has had powerful impact on the lives of many individuals and has changed the way medical services are provided to society. For example, new evidence in genetic research is changing the way we understand about risk of illnesses, kinship, and the ability to intervene in biological processes in order to alter physical or genetic characteristics. New techniques for visualizing interiors of the body (e. g. functional MRI/CT for body imaging) and sensing chemical changes inside the body (e. g. nanotechnology sensors) affect the way we classify and characterize “normal” function and behavior in the body.
Another unique area of research in medicine is the ability to grow cells into whole tissues utilizing stem cells. All of the novel ideas have one aspect in common – research funding. Medicine is an ever-changing science, and as technology improves, more money will be applied to medical research to allow for better diagnostic tools as well as better drugs to treat and cure diseases. Most recent data from 2012 suggest that about 120 billion dollars were provided for biomedical research in the United States. [2] The National Institutes of Health and pharmaceutical companies collectively contribute 33. 6 billion dollars and 34.
8 billion dollars, respectively, which constitute 28% and 29% of the total. Other significant contributors include biotechnology companies (22. 8 billion dollars, 19% of total), medical device companies (12 billion dollars, 10% of total), as well as federal, and state and local governments sources. Foundations and charities, led by the Bill and Melinda Gates Foundation, contributed about 3% of the funding. [2] This funding is directed towards universities and research institutions to assist in developing better devices and drugs.
These advancements in medical research will aid medical professionals to improve diagnoses and accurately treat diseases, which in turn will help to alleviate the total cost. For example, the portable Ultrasound machine was first developed for third world countries, but now has made a comeback in the United States. A dormant ultrasound machine costs roughly $25,000 while a portable unit ranges from $500-2500. [3] These machines have the same basic function, but at a fraction of the cost.
These savings could be used towards the patients and insurance companies to help provide the same care, at a much lower price. As we have learned in class, the cost of medicine has increased exponentially over the last few decades.
The costs seem to be growing at an exponential rate without any signs of decreasing. We learned of new cost saving principles in effect at hospitals and clinics across the country on ways to cut back on costs while at the same time improving the quality of care. We learned that many of the management tools (EMR, PHR) to help physicians and hospital with health records and the ability to share information across medical professionals. There is another side of medicine where technology has an enormous influence and that is the diagnostic tools and equipment that physicians use on a daily basis.
Heart disease is the number one killer in the United States, and congenital heart disease is the most common birth defect around the world. Over five million people in the U. S. have heart failure, and it is the cause of death for roughly 300,000 people a year. [4] Currently, lengthy MRI heart imaging technology has led to long wait lists, however new imaging technology has improved the way we see the heart today. These new imaging technologies can not only show the heart in 3D, but it can also show the direction of blood flow, the velocity, and how it corresponds with the fourth dimension – time.
The procedure is fast, non-invasive, and requires no contrast agent or general anesthesia; which reduces the risks associated with many cardiac patients. Until now physicians have measured blood velocity with MRIs that require a patient to be motionless for up to 90 minutes in order to capture the 20 to 30 slices needed to scan the entire heart. Ultrasounds are also used, but other anatomy can make it difficult to see certain areas of the heart. Furthermore, the images from both are typically 2D, and through computer rendering sometimes 3D.
With new technology the MRI/Ultrasound/EKG scan takes only fifteen minutes, and patients do not need to be still for a long period of time. From a short procedure scientists can produce remarkable images to measure how fast blood is flowing through various areas in the heart and the major arteries around it. Measurements and data produced by ultrasound, MRI, and a computer, which transfers the data to a projector and in turn, create a real time hologram. Scientists hope that new technology could be adapted to analyze blood vessel walls in order to identify weak areas of the heart, areas that are under immense stress that could result in aneurysms or build-up of damaging plaque.
This would have far-reaching effects for many patients with heart defects or at risk of cardiac problems. These new advancements can open up new opportunities for cardiologists. Cardiologist may be able to prevent heart attacks before they occur, with a non-invasive 15 min procedure. The number of lives that can be saved would be astronomical, while simultaneously saving money that could be used for treatments and follow up procedures for cardiac patients. With the new reform in healthcare over the last few years, more and more Americans now have access to healthcare insurance.
As of early 2015, 87% of Americans now have health insurance, however with high co-pays, high deductibles, and a lack of primary care doctors still affects many individuals from receiving healthcare. [4] For many, new health insurance does not mean access to affordable healthcare, and the Affordable Care Act (ACA) does not address the shortage of physicians. Innovative and cost effective ways must be created in order to bridge the gap between patients and access to physicians. One way to achieve this is through Telemedicine. Telemedicine is the concept of remote access to a physician via videoconference in order to address health care issues.
Telemedicine is gaining ground as an alternative to urgent care or the emergency department for many minor issues such as, ear infections and colds. Blue Cross Blue Shield of Massachusetts Director of Network Innovation Greg LeGrow stated, “Video visits have the potential to improve cost, access, quality, efficiency, as well as patient and physician satisfaction. ” [4] Data show that telemedicine can deliver quality outcomes comparable to in person office visits. A 2011 study by the Center for Disease Control study shows that eighty percent of adults discharged from the emergency room said they sought care at the ER due to a lack of access to a primary care provider (PCP) [5].
However, the ER is also the most expensive and least efficient way to provide non-emergent care, costing from $1,500 to $3,000 on average compared to $130 to $190 for a PCP visit [6]. A telemedicine visit can cost as little as $40 [3]. Access to a telemedicine provider can avert an ER visit on a Saturday night or prevent the need to arrange travel, childcare, or time off from work for an office visit during the week. Telemedicine is not designed to replace the patient-provider relationship; instead it serves as a convenient and cost-effective alternative to non-emergent treatment.
As a physician, I understand clinicians can be skeptical of new practice models and strategies because that is not how we were trained, and as physicians we want to see the evidence prior to adapting new methods. The good news is that we have evidence that telemedicine works, is safe, and cost effective. Providing Americans with accessible and affordable care will require new strategies. Telemedicine can and should be a part of that strategy. Patients want access primary care on their own terms, not those of the healthcare industry.
They want to be able to use their smart phones to find providers, schedule appointments, and view their medical records and with telemedicine they could also see a physician. Instead of video conferencing the doctor, what if you could order a doctor to your door by using your smartphone? With new applications like Heal and Pager that is now possible. These are smartphone applications similar to the on-demand car service Uber, but instead of a car, a doctor shows up at your door. Patients can download the application and then type in a few details such as, address and the reason for the visit.
After adding a credit card and a request for a physician; a physician arrives within 20 to 60 minutes for a flat fee of $99. [7] Heal is in the beta phase of testing and only located in the Los Angeles area, however it will expand to San Francisco and is set to roll out in 15 major cities throughout the United States this year. Similarly, Pager is also available in one city right now, New York City. [7,8] The doctors under this application are available and on call from 8 a. m. to 8 p. m. , seven days a week. These doctors arrive with a medical assistant and a home health kit with tools and gadgets to take the patients vitals and address their concerns.
In the early to mid 20th century, home health calls were the norm for physicians. It seems that utilizing this model will aide in offering quality care to the general population. Of course, there are limitation to home health calls, but many of the general concerns that add to wait times at urgent care clinics or ER waiting rooms can be reduced by home health visits. As previously noted, ER costs are a big concern the healthcare industry and are sometimes the first line of defense for a patients.
Home health calls will help alleviate the influx of non-emergency patients to an ER room, which can lower the costs and concurrently help improve the care to patients who are in need. If you think about it, health really starts in the home. In the current system of medicine, a patient comes to a clinic and states his or her problems. But by seeing where someone lives, a physician can look at the patient’s life with greater perspective. You can see how they live, how they eat, what their home environment is like, and what might be triggering their symptoms?
Think of it as being a detective, the physicians know there is a problem, but they are searching for “clues” to help resolve the issues.
It is very difficult to do that in the current system of medicine. All of these applications address the same issue – the access to primary care physicians. The average wait time to see a physician is over 20 days. [7] Consumers want appointments sooner, without sacrificing quality of care they receive. Many home health care calls can be services by the primary care physician, and only 10% is referred to a specialist. [7] These new ideas in healthcare will help solve two major problems: access to care and cost of care. With the development of advance technology, there is still one part of medicine that will continue to be necessary – the physicians.
With a growing and aging population, the demand for physicians has increased, and communities across the country are experiencing a shortage of doctors. In a 2014 study, conducted for the Association of American Medical Colleges (AAMC), predicts that by the year 2025 the United States will face a shortage of between 70,000- 90,000 physicians [10]. There will be shortages in both primary and specialty care practitioners, and primary care physicians will face the largest shortages. These shortages pose a real health risk to patients.
Because it takes between five and ten years to train a doctor, the projected shortages for 2025 would need to be addressed today in order to continue providing access to healthcare the populations. Resolving the potential shortage of physicians will require a multi- pronged approach. Some approaches will include concepts such as team-based care and utilization of technology in order to provide effective and efficient care. Medical schools and teaching hospitals will have to lead the movement in regards to team building among all health care professionals – nurses, pharmacists, and public health workers.
Furthermore, medical schools must assist in implementing a culture of “change” in medicine. It has been long understood that many physicians are reluctant to change. They are in the “if it ain’t broke, don’t fix it” mentality. Medicine is an ever-evolving science and breakthroughs and improvements are increasing at a rapid rate. Doctors should be willing to accept new improvements and implement them in to their practices. This culture needs to be addressed at the foundation, which starts with the medical schools.
Having an open mind towards new technology from the start will ease the gap between physicians and the use of technology in their practices. An additional, aspect that should involve the physicians is in the area of rules and law making. Lawmakers are creating guidelines and regulations with little consultation from physicians. Physicians have to implement these regulations, whether they agree with them or not; which can lead to pushback from physicians. I believe that young physicians should be included on healthcare reform discussions, and that strong leadership is needed to help influence the change that is needed in this industry.