Editor’s Note: Occasionally our blog features insights from outside contributors like those below from our colleague Rob McCray, who presented the following essay at last week’s mHealth Summit.
For the past 50 years, lives have been extended in industrialized societies but in the past 20 years rates of obesity and certain chronic diseases have skyrocketed in rich and poor countries. The prime culprit seems to be behavior-driven damage to our own bodies. Starting with the discovery of antibiotics, vaccines and antivirals, medical technology has saved millions of lives. Too many of us have a mindset that technology will save us from the consequences of our own behavior. This assumption threatens our lives, our pocketbooks and our social contract.
The physician community is full of wonderful individuals many of who have devoted all or portions of their career to improving the health of populations in need. As a medical industry, though, the profession has promulgated the notion that the physician-patient relationship is nearly sacred and that virtually no other individual or entity should be able to monitor or manage the physician’s actions. Key institutions representing doctors and other providers have devoted most of their efforts to protecting the prerogatives and enhancing the incomes of their members. The medical industry has claimed intellectual leadership for healthcare but the system it has built is failing to serve most of the world’s population and it is getting further behind the growth of human need and medical knowledge. New technologies have saved many lives but have not addressed the large scale shortage of services in most of the world nor has it maximized population health benefits in the rich world.
“Connected health” offers the promise of saving this situation but we cannot leave it to the medical establishment to lead this change. We as citizens and consumers, not as patients, must step up individually and via the institutions that we control to take charge of our own health and to set the expectations for the institutions that deliver healthcare and health supportive services.
Blame can certainly be allocated but most pertinent is Pogo’s observation at the dawn of the environmental movement in 1970, “We have met the enemy and he is us.” Our twin enemies are transaction-based medicine and inertia (personal and institutional). Residents of rich countries like the US have adopted lifestyles that are destructive of personal health and they have ceded responsibility for fixing their health to institutions paid by third parties. Neither the individual nor the provider has responsibility for outcomes in this model though the patient, his family and fellow taxpayers certainly suffer the consequences.
Consumer directed health (not just healthcare) can save this situation. The tools of “mHealth” include access to all the knowledge that is needed to reduce the need for healthcare and to select the best healthcare approach when it is necessary. As a movement, we can also reset public and private priorities so that they are supportive of healthier communities. We can also demand transparency in healthcare so that financial sponsors of services, be they individuals, employers or governments, can make informed choices about their expenditures and hold service providers accountable for outcomes.
So what is the role of physicians and the medical community in this effort? Individual physicians are in a unique position to improve our world. They retain the confidence of the public and have the power of both persuasion and the pen. Specifically, physicians can take an interest in improving the health of their patients rather than just caring for their diseases, and “prescribe” healthier living habits by directly addressing the harmful lifestyle choices that their patients present. These approaches are being institutionalized by practices ranging from the largest (e.g. Permanente Medical Group) to individual practitioners. As a politically influential industry, the medical community could become a major force for positive change. This is unlikely, given the pending disruption to the medical businesses of those who have succeeded in transactional medicine.
The mistake citizens and consumers must avoid is to assume that someone else will take care of the problem. We must embrace the responsibility and demand the tools that are needed to discharge it. This is not easy. It is difficult to change personal habits and the public’s mindset about health and healthcare. Entrenched bureaucracies, professions and institutions will continue to fight to maintain their positions. While difficult, technology and the knowledge that it is creating makes it possible to identify and implement the changes that are necessary to achieve this commentator’s goals of improving life and creating wealth, globally.
Let us know what you think.