The US medical system is the best in the world, by the simple measure of patients voting with their feet. How many US patients flee the US so they can enjoy the superior medical care in other countries? How many foreign patients come to the US in order to benefit from the superior medical care available here? This simple measure allows you to cut through the rhetoric and find the truth: instead of listening to what people say, watch what they do.
The US medical system would also benefit from radical change. It is not nearly as good as it could be. It’s not lacking new ideas, or more of the currently fashionable “innovation;” it needs to apply methods, systems and technology that are proven in wide-spread application in non-medical applications, suitably adapted for medical use.
I’ve already hit on a couple of juicy subjects in this blog. But they only scratch the surface. Here are some of the things I’m thinking about and will be blogging about.
Financial technology and healthcare technology
Both are heavily burdened by giant organizations, heavy regulation, ancient and expensive IT, and deep resistance to anything but surface change. But fintech is in a renaissance of game-changing innovation, while healthcare is a laggard by comparison. What’s this about? One simple example: in finance, when I applied for credit 30 years ago, I went to the bank and was subjected to an interview by a bank officer, who personally determined my credit-worthiness; today, complete automation yields better results with less time and cost. In healthcare, when I have disease symptoms, I go to a doctor who makes a diagnosis and recommends a treatment. It was the same 30 years ago, only now there's much more overhead typing stuff into computer systems, mostly for the benefit of various bureaucracies.
Drug discovery
In drug discovery, there is a huge gap between what we are capable of and what we let ourselves accomplish. As usual, regulations and bureaucracy impose expensive and outmoded barriers, resulting in widespread preventable deaths.
Innovation and best practices
There is a natural tension between assuring that patients are treated according to best practices, while allowing for innovation and expert adaptation. Our methods for resolving this tension are sadly deficient compared to non-medical fields.
Bad science
You would think that as a science-created and science-dominated field, there would be only the best science in medicine. Sadly, this is not the case. There is shockingly bad science at both the detail level and the global level.
Training and credentials
Healthcare is filled with extensive training requirements, certifications and tests. These are accepted as part of life in the field. Some of the credential requirements are well-intentioned -- but others are little but thin veneers of good intentions on top of a pile of self-dealing, and often make things worse for patients.This is best seen by comparison to other countries and other fields.
IT
The level of IT implemented at an average e-commerce website is, in general, vastly superior to the IT implemented at the very best medical institutions. On multiple dimensions, including cost, effectiveness, quality, and level of automation. If done well, excellent IT could be the foundation of a revolutionary wave of excellence in healthcare delivery and continuous innovation.
Conclusion and disclosure
I’ll be addressing these issues and more in future posts on this blog. But I’d like to emphasize: I’m taking the trouble to write this stuff down and make it available because it’s what I really think. I’m proud to be part of a partnership which invests in and supports leading-edge groups that are trying to change healthcare for the better, and I may refer to such companies in the future as I already have. But these posts and thoughts are promotional only in the sense that they promote concepts and practices that would raise the game in healthcare for everyone concerned.
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