I truly hope that very soon I do not have to make an appointment at the GP when I suspect signs of a disease, but my GP will send me a message that she spotted something irregular in my latest test results and my digital health data, so I’d better visit. Let me show you in detail how primary care should be carried out in the future!
Digital health should become an organic part of primary care in the future
I live a fairly healthy life. I use data to improve my lifestyle and to make better decisions by optimising my sleep pattern, my physical, my cognitive or my emotional abilities; and I had several genetic tests. What is the reason behind all my activities? I want to live a long life and work until the very end while being fit in body and soul. And I’m ready to sacrifice energy, time and money to reach it.
Data and digital technology is my guardian and my spear-hand in order to achieve my goals. Just look at my Excel spreadsheet experiment and all the stunning results I could achieve in one year! My GP also thinks that for example activity trackers have a ‘placebo effect’. When you know that your steps are counted, it increases your motivation, boosts your performance and you feel healthier. Thus, I believe digital technology should have a bigger impact on healthcare for making people’s lives better.
Although it is obvious that change starts with the individual, a lasting impact can only be reached when the direct environment also resonates with such changes. When people start to turn to digital technology to live a healthier life, the best response would be to advance the closest health sector to the individual, namely primary care in order to reflect the requirements of the 21st century.
So what does primary care look like now? What should be changed?
Healthcare today is not proactive, but rather reactive medicine. Patients usually visit the GP when they already have some serious problem; and since doctors are overwhelmed with tasks, they can only focus on treating acute illnesses. There is not enough data about the patient, and about the possible illness; most GPs and hospitals do not incorporate the latest proven scientific research into their practice. How could they? Data processing systems are usually not that efficient.
Doctor shortages are a global phenomenon. The World Health Organization (WHO) estimates that there will be a worldwide shortage of around 10 million physicians, nurses, and allied health workers by 2030.
At the same time, the need for healthcare services is rising. Illnesses are becoming easier to catch, civilizational diseases such as diabetes and obesity are on the rise; while aging societies need more and more care. The result? Long waiting hours at the GP or for appointments and surgeries, pricey, long, sometimes unnecessary procedures, random patient management, and unequal doctor-patient relationship.
How could we change it?
We need more data and a 180-degree attitude change! Data is essential for getting to know the patients, their situation, and their diseases as well as how to heal them completely and efficiently. Digital technology could help a lot in this respect. Healthcare trackers, sensors and wearables could serve with a swarm of useful biometric data in getting to know the health parameters and vital signs of patients and diagnosing their illnesses.
In January 2016, a man checked into a hospital’s emergency room in Camden, New Jersey. Because his heart was beating irregularly, doctors suspected he had atrial fibrillation. That is the most common type of arrhythmia, which can increase the risk of stroke. But to decide how to treat him, they needed to know exactly how long his heart had been acting up. That’s when one of the physicians noticed a Fitbit Charge HR on the patient’s wrist, and it had the answers they were looking for.
This was one very early example of how useful data extracted from wearables could be. That’s why such events should not happen on a randomised basis, but GPs, as well as hospitals, should rather incorporate data from healthcare trackers, sensors, and even fitness wearables into their practice on a systemic level.
What should the first encounter with your GP’s office in the future look like?
Somewhere in the 2030s. Adam scrolled down on his phone and asked Mimi, the healthcare chatbot about the selection of GPs in the neighborhood, where he just moved in, a very neat area in Amsterdam. Based on Adam’s preferences, Mimi offered three possible choices, and he selected one. The chatbot made an appointment for him for the next day. By the time, he went there, his previous doctor sent over all the necessary healthcare data about him after he consented to the necessary forms about data privacy. Adam could also take all the results of his genetic tests to the GP – data about drug sensitivity, his risks for monogenetic conditions or multifactorial diseases or mutations -; as well as the data from the health trackers, he uses for measuring his physical activity, blood pressure and tracking his sleep.
Adam went to the GP’s office, which rather looked like a business meet-up; and had a very friendly chat with his new doctor, who already knew about his previous knee-replacement operation as well as his peanut allergy. Then she asked a couple of further questions about his health and examined him thoroughly: ECG, blood test, knee X-ray, etc. The whole exam was less than an hour. Afterwards, the doctor gave Adam a summary of the current state of his health and estimated his risk for different diseases. Based on this information, the doctor and Adam worked out a prevention plan to avoid these health risks and set out the parameters of a personalised healthy lifestyle. They agreed to set up various targets concerning his physical activities, his dieting habits as well as factors reducing stress.
Ideally, the GPs of the near future will rather act as health coaches. They will interpret health data if something is not clear, give advice when results are not optimal, and spot and check irregularities based on data as soon as possible.
What happens in practice?
I always wished Adam’s story could be mine. For years, I have been looking in vain for a GP who thinks the same way about prevention and digital health as I do. Finally, a few years ago I found her. She believes in the equal-level collaboration I’m evangelizing rather than the old hierarchy of the doctor-patient relationship. And she is a data freak just like me.
So, when we first met, I brought to her
- the results of my genetic tests: what drugs I’m sensitive to, what metabolic conditions I carry, what major mutations I have (e.g. Leiden that increases my risk for deep vein thrombosis), and what risks I have for multifactorial conditions.
- data sets about my health parameters in terms of sleep quality, physical activity, blood pressure
- major lab markers from the past years in an Excel spreadsheet so she didn’t have to look through thousands of data points, just what really mattered
- the need for a long-term prevention program.
What was my GP’s reaction?
Instead of jumping out of the window in fright from the data tsunami, she got curious and excited about discovering my health background. First and foremost, she examined all the available information based on my data as well as the data in the healthcare system. Then she drew up my family tree with the major diseases and causes of death, carried out a full physical examination, checked all my tests and lab markers, examined my lifestyle, and then came up with the risks for different major conditions based on international data and evidence.
What was the final verdict and how will my GP and I work together in the future?
At the end of the process, we agreed upon a prevention program concerning when and what kind of health tests should I undergo. This is a difficult issue by the way. We could have a full-body MRI every year, but it is expensive and so far there is no strong evidence that it prolongs life, so we said no. You really need to be considerate and sane while deciding upon a regimen of tests for the long term. She also gave me pieces of advice about my lifestyle. As I exercise 30 minutes per day on average and have never smoked, I could only slightly improve my diet and alcohol intake. But now we know what to keep an eye on:
- I have a higher chance of thrombosis
- I have to be careful with certain drugs in the future because the probability of having serious side effects after taking them is high (e.g. statins for high cholesterol)
- My chance for melanoma and basal cell carcinoma is very high, so I have to do an annual dermatology checkup
- I also have to keep my BMI under 25 because I have a high genetic risk for obesity and insulin resistance
We meet twice a year if I have no issues. In the meantime, I keep on living a physically, mentally and emotionally active life and measure data. When something is different, I let her know.
This is what primary care should look like globally. She doesn’t order a huge range of additional tests just because she could. We made all these decisions based on evidence. Moreover, she is eager to use the data I bring to the table.
Digital health at its best.
So, how could we help GPs to incorporate digital health into their everyday practice?
There are many factors that hinder the introduction of digital technologies on the most basic level of healthcare. As my GP said, the major nemesis is lack of time. Busy physicians find it difficult to incorporate into their everyday practice to work with digital information. Also, there is no separate allocated time to visit your doctor only for preventive visits. So, first of all, we need to make time and space for digital technologies in healthcare. She also mentioned another important factor, the compatibility issue. Medical programs used in the GP’s offices might not be compatible with the health trackers’ own software.
My GP agrees with me that in the last few years, there has been a growing interest in health prevention and active involvement in health from the patient’s side. It is not a surprise that there are already examples that patients are bringing their healthcare trackers or sensors to their medical professionals to check their data – and not the other way around.
Lifestyle medicine needs to become mainstream
You might not have heard of lifestyle medicine before now, this field is relatively new, and even its Wikipedia entry is far from being very extensive. However, it is a very important new way of practicing medicine. In layman’s terms, we could say that its goal is to support patients to live healthily as long as possible, focusing on prevention instead of treatments.
The American College of Lifestyle Medicine (ACLM) initiated the steps to establish the standards shaping lifestyle medicine as a field of its own. ACLM defines it as “the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life”.
The field draws parallels to nutrition and dietetics but involves a more holistic approach. The ACLM describes six pillars of lifestyle medicine:
- predominantly whole, plant-based nutrition, rich in fibres and nutrients
- regular and consistent physical activity that can be maintained on a daily basis
- recognising and coping with stress
- avoiding substance abuse
- ensuring quality sleep
- social connectedness to ensure emotional resilience
For those healthcare professionals and students with an inclination toward technology, lifestyle medicine might be the area they are longing to specialise in. It’s one where they actively contribute to patients’ lives while using novel technologies for general healthcare purposes. If you are interested in lifestyle medicine, we introduced this field in more detail here.
21st-century doctors can have a hospital’s worth of diagnostics in their bags
The breathtaking development of portable diagnostics tools also supports the transformation of primary care. Digital stethoscopes, card-sized ECGs, portable ultrasounds, and portable vision tests – among others – make a thorough checkup a breeze, and you don’t have to leave your doctor’s office for it.
We listed 7 of these ultra-portable diagnostic tools in this article. So if we have all these amazing devices readily available, why don’t we see them everywhere?
Firstly, it’s simply because many aren’t aware of the existence of such devices. Doctors are often busy with their daily routine and keeping up with the latest research about what technologies like CRISPR can offer but don’t keep in touch with the technologies available right away. Some might even think that those devices aren’t for sale or are expensive. But in fact, they have been approved by regulatory bodies, are readily available on the market, and aren’t as expensive as their traditional counterparts.
For instance, the EyeQue Personal Vision Tracker costs $35, less than a designer frame! The Littmann Master Cardiology stethoscope costs around $230 while the Eko Core Digital Stethoscope is priced at $330. These aren’t promotional adverts but mere comparisons and we’ll expect the price to go even lower as technology progresses.
Additionally, there still is a reluctance to adopt new technologies. Many think of these devices as the end of the art of practicing medicine, when in fact, they are present to help doctors build better relationships with their patients by getting faster results with more data. Such devices need adopters to make digital health a global reality and it would be better sooner than later.
Healthcare should be put in perspective on a systemic level
Doctors are traditionally trained to cure illnesses, Dr. Vernes says. I believe this attitude has to change, as technology is at our heels, and we need to keep pace with it. Also, my GP mentioned that the Hungarian system does not reward doctors’ efforts in preventive medicine. This phenomenon is a systemic problem and could be prevalent in other countries as well. She explained that the reimbursement is procedure or capita-based and not outcome-based. The healthcare system is not “thinking” in terms of prevention mostly because positive results only show after years or even decades on the population level.
Now, that’s the attitude we need to change. You cannot and should not think in the short term in healthcare, because the result will be the usual “firefighting”. We all have to think in perspective about the future of healthcare, and that future must come to terms with digital technology.
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