Fascinating and thoughtful read (especially for an early Saturday morning with a full cup of coffee). I am new to reading your posts, Ben, but find them thoughtful and thought provoking.
In the consumerism topic, I would posit that the concept of consumer and patient are not mutually exclusive. In fact I think there is a role for both depending on the type of care or medical event.
I would suggest we are at a consumerism tipping point more than ever before in healthcare. This may fly in the face of the failures for Walmart/VillageMd etc in terms of retail health centers but I actually would suggest they are indicative of the change (painful while happening) that is going to happen to the primary/urgent/preventative side of healthcare. I see a path where third party payers can be disintermediated for these services and bring the person closer to the provider.
"generalizability" I struggled to pronounce and would have no chance of spelling.
There is no doubt that in today's world with the access to information, video content and communication that EBM/SDM could provide a much better care for the patient as well as a better healthcare system. I've always found that in MSK most doctors (given the time) enjoy the teaching and explaining of procedures almost as much as they enjoy preforming them. I believe this is evidenced in the level of education that MSK doctors and their office provide the patient.
Sadly there is another factor that is blocking the pathway to EBM/SDM and that is insurance/medicare.
In today's market the time that the physician used to spend with the patient is replaced by the time they have to spend with the payor. When you add to that the reality that the payor in a lot of cases is incentivized to deny even EBM that was arrived at through SDM you arrive at where we are today. A system that has all the tools to provide EBM/SDM that is too broke to adequately use them.
You frequently talk about and look for why technology or digital medicine is so slow to adapt and I believe the reality is that the wrong people are creating the tools for the wrong reasons. I believe one of the biggest reasons consumerism doesn't work in the delivery of care is the reality that like it or not profitability has no good role in the delivery of care. This is why hospitals started out as "not-for-profit". Those facilities recognized the need to generate the revenue necessary to support doctors nurses and other critical staff, where it went wrong was when the system had to also support executives and shareholders for hospitals as well as insurance companies, This led to far to much of our healthcare dollars and resources being channeled to things that don't directly apply to EBM/SDM.
I know I sound like a broken record but it just seems obvious to me that the system needs be be stripped down to the patient physician level (isn't that what EBM/SDM really is) and built back up from there.
Thanks again Ben for your insight. I’d like to add another approach that has the potential to refine treatment recommendations and fits right in with EBM/SDM. That is, Personalized or Precision Medicine, the use of diagnostic tests that can ensure drug response (or reveal non-response) or AI-based predictive models that can analyze a patients profile and predict response to treatment. These two approaches need more development but have tremendous potential.
Fascinating and thoughtful read (especially for an early Saturday morning with a full cup of coffee). I am new to reading your posts, Ben, but find them thoughtful and thought provoking.
In the consumerism topic, I would posit that the concept of consumer and patient are not mutually exclusive. In fact I think there is a role for both depending on the type of care or medical event.
I would suggest we are at a consumerism tipping point more than ever before in healthcare. This may fly in the face of the failures for Walmart/VillageMd etc in terms of retail health centers but I actually would suggest they are indicative of the change (painful while happening) that is going to happen to the primary/urgent/preventative side of healthcare. I see a path where third party payers can be disintermediated for these services and bring the person closer to the provider.
"generalizability" I struggled to pronounce and would have no chance of spelling.
There is no doubt that in today's world with the access to information, video content and communication that EBM/SDM could provide a much better care for the patient as well as a better healthcare system. I've always found that in MSK most doctors (given the time) enjoy the teaching and explaining of procedures almost as much as they enjoy preforming them. I believe this is evidenced in the level of education that MSK doctors and their office provide the patient.
Sadly there is another factor that is blocking the pathway to EBM/SDM and that is insurance/medicare.
In today's market the time that the physician used to spend with the patient is replaced by the time they have to spend with the payor. When you add to that the reality that the payor in a lot of cases is incentivized to deny even EBM that was arrived at through SDM you arrive at where we are today. A system that has all the tools to provide EBM/SDM that is too broke to adequately use them.
You frequently talk about and look for why technology or digital medicine is so slow to adapt and I believe the reality is that the wrong people are creating the tools for the wrong reasons. I believe one of the biggest reasons consumerism doesn't work in the delivery of care is the reality that like it or not profitability has no good role in the delivery of care. This is why hospitals started out as "not-for-profit". Those facilities recognized the need to generate the revenue necessary to support doctors nurses and other critical staff, where it went wrong was when the system had to also support executives and shareholders for hospitals as well as insurance companies, This led to far to much of our healthcare dollars and resources being channeled to things that don't directly apply to EBM/SDM.
I know I sound like a broken record but it just seems obvious to me that the system needs be be stripped down to the patient physician level (isn't that what EBM/SDM really is) and built back up from there.
Thanks again Ben for your insight. I’d like to add another approach that has the potential to refine treatment recommendations and fits right in with EBM/SDM. That is, Personalized or Precision Medicine, the use of diagnostic tests that can ensure drug response (or reveal non-response) or AI-based predictive models that can analyze a patients profile and predict response to treatment. These two approaches need more development but have tremendous potential.