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The biggest medical failure of today

Published: 24/04/2019

Let me take you to 1971: Henry Moss, the president of The New York Academy of Sciences (surgeon and scientist) warned of the trend of super specialization. Quote: “the obvious failure of our system to fill the void created”. On the contrary, he argued for the broad perspective: the advantage of establishing new relationships and cross-fertilization between disciplines – being able to conduct interdisciplinary discussion, work on the edges of the field and investigate. He also pointed out the importance of exploring underexposed areas of research and subsequently involving other researchers. Now, half a century later, I wonder: did we care? Was he wrong? No: Moss is more right than ever!

Just from Henry Moss to the practice now. With this example I hope to clarify how behavior, environment and mental functioning influence our medical outcome. Between the many consultations of people with a new diagnosis of lung cancer, I am also fortunate to be able to propose a treatment aimed at a cure. It concerns the patient with the so-called “chance finding”. Usually without complaints on the basis of the disease with the limited tumor volume.

Then that is the time to delightfully propose stereotactic radiotherapy: extremely high doses of radiotherapy with millimeter precision. In the patient this joy appears to be a lot more limited. In addition to the fear about the diagnosis, there is also fear of the unknown of the treatment, how to combine it with the family situation, the transport, what is and what is not allowed and so on.

What do we not take into account?

Stop smoking then seems like a detail to the patient. Yet smoking not only has a significant negative impact on the mental state (coping, depressive and anxious feelings), it also works against radiation, regardless of the effect on health in general!

But even if the patient wants to stop, his environment appears to be a strong incentive to relapse, even if it had been effortlessly successful after a few days of hospitalization. Of course, as a reader, you have long had solutions for the above patient in mind. But how many other factors are there that we do not know about now and therefore do not take into account?

Although we have been able to realize top care of a super specialist level, we have unfortunately not progressed further than analogous linking of care information. I’m not even referring to the “Sherlock Holmes Basic Skill” of a physician today: searching for crucial information among scanned letters or digital notes from colleagues and looking for missing information in other healthcare facilities.

I mean the other 90 percent of what determines our health: economic factors, education, genetics, social support network, behavior and physical environment. These are largely ignored because we simply do not have a view of them.

Use technology for better healthcare journey

Today, technology should be able to provide a smooth image for our patient. Yet now no doctor has a complete picture of the patient! We only see a limited part, of which advice and treatment make up an even smaller part. To rephrase the question: how do I make a real contribution to the health of my patient if I do not know his journey through the healthcare landscape?

I expect that the use of technology will provide more insight for the practitioner, but also for the patient. The result: better decisions and self-reliance in the long term. For example, in some cases treatment may not turn out to be a desirable choice, while it is the most obvious from the current care perspective. Or do certain interventions actually contribute to more success with current treatments.

Really listen to the patient …

One last example before I encourage you to comment on my translation of Moss to this time. Last week, one of my patients told me at the end of a combined chemoradiation treatment: “It went slightly differently than we expected, I got more complaints, had some specific questions. Still, I feel like I have so many practitioners, but I have to keep an overview myself. You just have to be lucky that someone really listens to you for a moment. It seems there is no one for me. ” This really struck me. The image of this patient versus the long days of the doctors doing their utmost to deliver the treatment as well as possible.

… And see all of the person!

If I could interpret Moss’s words half a century later, I would translate it into “doctors behind counters, tied together analogously.” A huge medical miss, but one for which a solution is available! If we use technology to provide us with an intuitive picture of what still remains “out of scope”, as doctors we will see the whole person!

Who should ask for this differently than we as a doctor? The hospital management? The industry? Do they have that knowledge from the heart of healthcare that we deal with every day? Is this a new domain where we should have leadership? Doesn’t the patient expect this from us? Aren’t we responsible for the best possible care?

What do you think? What do you see as your contribution as a doctor today and tomorrow? Do you disagree? Let us know, comment! I am looking for the doctor who is interested in this topic! Twitter #DDD or datadrivendoctor.

About the author

Gabriëlle Speijer is a Radiation Oncologist at the Haga Hospital, founder of the healthcare innovation company CatalyzIT, HIMSS Future50 International HealthIT leader and member of the ICT&health editorial board.