4 disturbing trends in health care

4 disturbing trends in health care – Praveen Suthrum | KevinMD | Aug 2018

I agree with the author that health care is changing dramatically and not necessarily in a good direction. This article points out some fundamental issues that must be addressed before any “progress” can be made.

It’s easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry.

Here are four trends that are changing health care but on the surface are too unsexy for us to care about.  

Trend 1: The doctor-patient trust is at an all-time low

The relationship between doctors and patients has transformed from the one where the doctor intimately grasped our history by treating everyone in the family to a transaction-based activity.

Patients have changed from care receivers needing sympathetic treatment to care buyers with high demands.

On one hand, doctors inherit a Hippocratic oath that calls for warmth, sympathy and preferring prevention of disease over cure. On the other hand, they are pressured by new needs of ROI in the medical business, which calls for monetization of expensive resources (often required to meet new demands from patients).

Additionally, with the supposed “crisis” of overprescribed opioids, the government, in the form of various agencies (CDC, DEA, FDA) has stepped in and is practicing medicine by determining what amounts of what medicines we should be given.

This must be exceptionally demoralizing for pain doctors trying to help their patients live with a decent quality of life.

When they are not allowed to prescribe the necessary opioids, they must stand by and watch their patients suffer horrendous agonies that had been under control before these latest prohibitions.

The end result is a system that’s low on trust.

Especially when both doctor and patient records (supposedly confidential health information, but…) are constantly being monitored for opioids, and the DEA lurks ready to pounce on any amounts they consider “too much”.

Trend 2: More testing is leading to disease management not resolution

Amidst a background of low trust, both doctors and patients have increased their reliance on testing from pathology to imaging to radiology.

At an earlier time, doctors relied more on an intuitive sense based on examining presenting symptoms and conducting thorough physical exams. However, such an approach today could invite lawsuits from patients when a gut-call without data goes wrong.

Therefore, we not only have greater number of tests for every disease condition but also an overall increase in the total number of lab tests performed.

  • the premise of lab tests is prevention of disease,
  • the reality is an associated over-treatment that results in ongoing disease discovery and management.

This trend of becoming lifelong patients is likely to continue as we find more ways to capture data from the body.

Lifelong patients are extremely desirable because they provide a lifelong source of income for the corporations involved in healthcare.

Curing a patient sets them free and then there’s no more money to be made off them. Why would any capitalist corporation want this?

With investors clamoring for profits, it doesn’t even make sense to seek a cure when maintaining patients on lifelong treatments or medications creates a much more reliable and long-lived source of income.

Trend 3: New findings are putting past guidelines into question

After recent findings, the US Preventative Task Force, considered a gold standard for screening, recommends that women go through annual screening for breast cancer after age 50 instead of an earlier guideline of age 40.

This puts into question the decision by millions of patients who went through annual mammograms based on earlier recommendations.

Adding to the confusion, not all doctors or medical societies agree with these changes.

Doctors on their part must feel disoriented too — having implemented earlier guidelines so surely and now having to implement new guidelines not so surely. It’s another shift that alters the doctor-patient relationship.

Opioid prescribing is one of the most extreme examples,.

Guidelines in the 1990s urged doctors to aggressively treat pain with opioids, but then the new guidelines from 2016 urge doctors to avoid using opioids at all, even when the patient’s pain is extreme and destroying their life.

It must be disheartening to have your professional practice yanked around by the whims of the cultural moment, to be beholden to capricious public sentiment driven by self-appointed “experts” and media hype that spreads their nonsense uncritically.

Trend 4: Our environment is changing the rate at which we get disease

The more modern our environment, the greater seems to be our long-term disease-risk.

From refined oil to sugar that pours, we’ve managed to create food that looks great on the outside but has in turn messed with our insides.

Our modernization is affecting us biologically in ways we never imagined and now we have to deal with the messy aftermath.

We stumble around trying to figure out what is causing these new forms of diseases and then try to eliminate the cause or, much more often, how to manage the resulting disease.

Unfortunately for opioids, they have been branded as the “cause” of the rising overdoses so many groups are trying to eliminate their use entirely.

This is certainly profitable for “interventional pain management specialists” (PROP members) when desperate patients turn to these dangerous invasive procedures because their well-functioning opioid therapy is stopped by the new healthcare “overseers”, like corporate officers, government agencies, or law enforcement.

What we believed to be advances hitherto seem to have now altered the natural course of our bodies.

From 2001 to 2009, Type 1 and Type 2 diabetes significantly increased among children and teenagers. Puberty age has steadily dropped.

We can always argue whether we have enough conclusive data to link these changes to our environment but it’s not difficult to observe that there’s a shift at play around us.

Changing the questions we ask

As unexciting as they may seem, these trends are disrupting our industry for good. We can choose to ignore them and reserve our enthusiasm for the next medical toy.

Or we can accept the obvious reality that something’s a little off here and play more evolved roles as patients, doctors, clinicians, technologists and business people by changing the questions we want answers for.

Author: Praveen Suthrum is president and co-founder, NextServices and blogs at redo | healthcare.


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