A Future of Medicine
This article will discuss the future of medicine. This should be generally a fun topic and is based on my understanding of current trends. It will allow some of us to see what I feel the future holds somewhere within the next five to ten years.
The only bad news that I foresee in the future, other than the insurance discussions that we have had before concerning the quality of care, is that, as part of another cost-cutting measure, the patient will interact with the physician further down in the chain of patient care. Please see the accompanying diagram.
The good part about the future of medicine is that with the newer studies, both epidemiologic and laboratory studies, the care will be much more accurate in its determination.
Concerning first the history, the history that will be taken by a physician in the future will have more emphasis on genetics and more emphasis on risk factors than the history taken by physicians today. This will be an outgrowth of the study of the human genome. After this project is nearly completed, a more complete understanding of the relationship of heredity versus environment will be reached, and it will be the one aspect that we can correlate with the disease process.
Concerning the physical exam, this will be a very interesting time for people. The routine physical exam, as patients and physicians are familiar with it today, will be obsolete. In fact, it is obsolete at the current time. The physical exam where the physician palpates arteries and listens to your chest and heart, palpates the abdomen, and checks the neurologic exam is basically obsolete. A technician with an ultrasound machine can look at your arteries, your heart, your abdominal organs and your extremities with much more accuracy and detail and just as non-invasively as a physician's exam. At the present time this is not done on a routine basis for several reasons. One, the physician doesn't know how to do the actual test. Two, the time taken to do these tests would be about two to four hours for a physical. Three, the cost of each individual test, an echocardiogram, ultrasound or abdominal study by ultrasound is in the two to three hundred dollar range per test, whereas the physician's exam is approximately one hundred dollars per physical. In the future, I suspect the reimbursement for ultrasound of carotids, echocardiograms, the abdomen and the legs will come down in price, and these studies will be required for a proper physical. There is no question that these studies, with a chest x-ray and laboratory studies will supersede most aspects of a physical exam provided by the physician.
Alternatively, further out in terms of studies, I could foresee a time when the MRI machine, Magnetic Resonance Imaging machine will be used to do whole body imaging with interpretation by computer analysis to supersede the physician being trained to examine and diagnose a patient. There will still be physicians at those times to corroborate those findings but I could even see where the MRI could be used to examine a person for a sore throat, because there are changes in the throat that the MRI can pick up even for this simple study. The problem right now is that the MRI would cost eight hundred dollars and you can't afford to use it to examine a sore throat. But in five or ten years, I can foresee that the MRI will be reimbursed at a proper rate and they will get thirty dollars for examining a patient and then it will be cost effective.
In terms of studies themselves, for a particular patient, many of the tests will be done based on studies that document the efficacy of a test. At the present time, we do a number of studies on patients without clear proof that they actually benefit overall medical effectiveness. The good part will be that the people will get the tests that are most efficient to be run on a screening basis. The bad part is that there will be people who will be missed who would have been picked up when they did a larger panel of studies. These people would have been picked up at an earlier time. An example of this is parathyroid disease. With calcium being run on general chemistry panels, a calcium that was off over a number of years uncovered many cases of hyperparathyroidism, although the patients were clinically unsuspected. So, there is some routine value in these studies. Many people have been found to be diabetic by these routine studies with elevated blood sugar levels.
Overall, the consensus is that you should only do what is essential, but I think the inaccuracy of this system makes it advantageous to have some of these extra studies done on a more routine basis.
Concerning the medical office, in the future as predicted for other offices nationwide, there will be no paper. There will be electronic charts. I suspect the charts will be accessible by phone twenty-four hours a day for information from remote places such as a hospital emergency room, an insurance company wanting to review the records or peer review just checking to make sure they are up to standard.
Another change that will occur in the doctor's office is that more studies will be done actually at the doctor's office. These ultrasound studies that now take place in a radiology suite will actually take place at the doctor's office. Laboratory studies, including routine labs, can be expected over the next several years to be pushed even more in favor of the doctor's office doing the studies, Medicare notwithstanding.
There are many positive developments in the evolution of medical care at the level of patient care which promise better health for Americans in the future. The question to ask yourself as a patient is, is my doctor keeping up with this improvement in quality in terms of office modernization, or are they keeping with the older routines, which are good but not state-of-the-art?