The Future of Medicine

Here is a new megatrend. There will be a wave of new hospital mergers in the coming years. Hospitals need to access capital in order to purchase expensive equipment and build new facilities. But margins are getting very thin and access is very difficult for the smaller, stand alone hospital. So look for many mergers soon.

We do not have enough primary care physicians [PCPs] and the shortage is especially acute in rural and urban poor areas. In the USA there are about 30% PCPs and 70% specialists. In other countries of the developed world, the ratio is the opposite. And PCPs now need to attend to many more patients with complex, chronic diseaes that last for life and require a team-based approach to care. Rather than be an interventionalist, the PCP must become an orchestrator.

The population is growing; we are aging; and more and more individuals have not curable acute illnesses but complex, chronic conditions that will persist for life. As a result there is a need for more and more medical services including physicians, other care givers, hospitals, ICU beds and high tech equipment. And there is a critical need for a change from our acute care approaches to disease and care management, team-based care and better coordination of care.

Increased age and our lifestyle behaviors have a major impact on healthcare costs. Like an older car, an older body has parts that are more likely to need repair or replacement. We will continue to age but we can slow the process of aging with mental and physical exercises. As a society, we are overweight, poorly fed, highly stressed and lack exercise. These behaviors along with smoking will lead to huge increases in our total medical costs in the years to come.

New pharmaceuticals have had a major impact on health and life, but many of the newer drugs are prohibitively expensive. Some are marginally valuable. Others are superb drugs but are all too often used in lieu of making life style changes that would eliminate or at least modify the underlying problem. We need to change our approach to expecting a drug to solve our problems when simpler, less expensive approaches would work even better.

Medical technologies are often very expensive. The question at hand is are they worth it or do they just drive up the already high cost of medical care? In this podcast we explore how some technologies are very useful but need to be used only when necessary.

The United States is the only country in the industrialized world that does not assure insurance to cover the catastrophic medical care costs of all its citizens. But Republicans and Democrats differ widely on how to address this problem. Here is a proposed compromise that offers universal coverage but with a change in the tax code, more personal responsibility for behaviors, and reduced insurance costs through lessened mandates. It also returns to true insurance, not prepaid medical care. Use high deductibles and HSAs but offer primary care and preventive care to those who truly cannot afford it.

As a result of engineering and computer science advances we can expect to see major improvements in imaging - both anatomic and now also molecular or functional imaging; smaller and more powerful medical devices; big changes in the operating room including simulation and robots; and a functional electronic medical record. Look for acceptance of complementary medical techniques such as acupuncture, massage and meditation. And expect hospitals to become more safe for you and your loved ones.

We review here the five basic medical megatrends that will occur in the coming five to fifteen years including the concept of customed-tailored medicine, the change from "diagnose and treat" to "predict and prevent;" repairing, restoring or replacing tissues or organs; the advent of truly electronic medical records and fewer preventable medical errors. Look for major advances in genomics, stem cells, vaccines and transplantation as a result of much greater understanding of basic biomedical science.

Your medical record is indeed your medical record even though it may be currently stored in your doctor’s office or the hospital’s record room. You need to have ready access to that information and need to be able to pass it on to any healthcare provider you choose, securely.

"The electronic medical record will arrive over the next decade, but inparts and pieces. It will become your medical record, not the doctor's or hospital's. Your record may be on a a chip in your pocket or instantly available from the internet."

Full digitization of medical information – which will still take 5 to ten years or more to achieve - will allow access to medical information at any time, at any place, and in so doing will greatly improve the quality and safety of medical care—your medical care. Digitization will assist continuity of care by providing the right information at the right time to allow for the correct choices in care. Telemedicine and distance medicine will prevail.

Robotics will become as important in surgery as industrial robots have become to manufacturing. They can overcome certain obstacles or barriers, such as accessibility to certain tissues (small incisions), distance (telesurgery), dexterity (the six degrees of freedom or a wristlike motion), speed and they do not get tired. They offer the potential to transcend certain human limitations to increase consistency and quality.

Tomorrow's operating rooms will be highly dependent upon breathtakingly superb images that will allow the surgeon to know - in advance - what to expect during a specific individual's surgery. And simulators will be universally used by trainees before ever being allowed into the OR. The measure will be competence, not just numbers of cases done. Better surgery and better training.

As medicine advances, there will be less need for surgery and the surgery done will be much less invasive. Some procedures traditionally done in the operating room will now be done in the radiology department using catheters rather than scalpels, in shorter time frames and will less recuperation time needed.Play Now

The OR of the Future has four major megatrends. Fewer procedure will need to be done. Many procedures will be done outside the OR. The OR will have much more functionality. The OR will depend on new technologies such as simulators, image guidance and robotic assistance.

Nanomedicine - Ever more small devices are being created now with sizes so small that they cannot be seen with a microscope -- but they can help in diagnosis and treatment in ways never before available. For example, a nanodevice an find a tumor cell, attach to it, show where it is on an image and then deliver a drug to destroy it.Play Now

Smaller and more powerful devices with very long battery life have been created to help control the heart beat, improve heart pumping, decrease the number of epileptic seizures and even decrease depression for those not well treated by drugs. Soon there will be insulin pumps that can sense the body's blood sugar level and inject just the right amount of insulin -- and many more to come.

What we used to call "X-rays" are dramatically changing with superb anatomic images that show some of the smallest details of our organs and the ability to "see" actual function within tissues and cells. And they are not just used for diagnosis anymore but for actual therapy of problems formerly treated in the operating room. With all of the information in digital format, images can be viewed at anytime, at anyplace and by any (authorized) person.

Expect new vaccines to prevent not only infections but also to prevent and treat many chronic diseases like multiple sclerosis, coronary artery disease, and Alzheimer’s. And their will be vaccines designed specifically for an individual – custom tailoring again – to treat residual cancer.