The Future of Medicine

We do not have enough primary care physicians [PCPs] and the shortage is especially acute in rural and urban poor areas. In the USA there are about 30% PCPs and 70% specialists. In other countries of the developed world, the ratio is the opposite. And PCPs now need to attend to many more patients with complex, chronic diseaes that last for life and require a team-based approach to care. Rather than be an interventionalist, the PCP must become an orchestrator.

The population is growing; we are aging; and more and more individuals have not curable acute illnesses but complex, chronic conditions that will persist for life. As a result there is a need for more and more medical services including physicians, other care givers, hospitals, ICU beds and high tech equipment. And there is a critical need for a change from our acute care approaches to disease and care management, team-based care and better coordination of care.

Increased age and our lifestyle behaviors have a major impact on healthcare costs. Like an older car, an older body has parts that are more likely to need repair or replacement. We will continue to age but we can slow the process of aging with mental and physical exercises. As a society, we are overweight, poorly fed, highly stressed and lack exercise. These behaviors along with smoking will lead to huge increases in our total medical costs in the years to come.

New pharmaceuticals have had a major impact on health and life, but many of the newer drugs are prohibitively expensive. Some are marginally valuable. Others are superb drugs but are all too often used in lieu of making life style changes that would eliminate or at least modify the underlying problem. We need to change our approach to expecting a drug to solve our problems when simpler, less expensive approaches would work even better.

The United States is the only country in the industrialized world that does not assure insurance to cover the catastrophic medical care costs of all its citizens. But Republicans and Democrats differ widely on how to address this problem. Here is a proposed compromise that offers universal coverage but with a change in the tax code, more personal responsibility for behaviors, and reduced insurance costs through lessened mandates. It also returns to true insurance, not prepaid medical care. Use high deductibles and HSAs but offer primary care and preventive care to those who truly cannot afford it.

As a result of engineering and computer science advances we can expect to see major improvements in imaging - both anatomic and now also molecular or functional imaging; smaller and more powerful medical devices; big changes in the operating room including simulation and robots; and a functional electronic medical record. Look for acceptance of complementary medical techniques such as acupuncture, massage and meditation. And expect hospitals to become more safe for you and your loved ones.

We review here the five basic medical megatrends that will occur in the coming five to fifteen years including the concept of customed-tailored medicine, the change from "diagnose and treat" to "predict and prevent;" repairing, restoring or replacing tissues or organs; the advent of truly electronic medical records and fewer preventable medical errors. Look for major advances in genomics, stem cells, vaccines and transplantation as a result of much greater understanding of basic biomedical science.

Full digitization of medical information – which will still take 5 to ten years or more to achieve - will allow access to medical information at any time, at any place, and in so doing will greatly improve the quality and safety of medical care—your medical care. Digitization will assist continuity of care by providing the right information at the right time to allow for the correct choices in care. Telemedicine and distance medicine will prevail.

Robotics will become as important in surgery as industrial robots have become to manufacturing. They can overcome certain obstacles or barriers, such as accessibility to certain tissues (small incisions), distance (telesurgery), dexterity (the six degrees of freedom or a wristlike motion), speed and they do not get tired. They offer the potential to transcend certain human limitations to increase consistency and quality.

What we used to call "X-rays" are dramatically changing with superb anatomic images that show some of the smallest details of our organs and the ability to "see" actual function within tissues and cells. And they are not just used for diagnosis anymore but for actual therapy of problems formerly treated in the operating room. With all of the information in digital format, images can be viewed at anytime, at anyplace and by any (authorized) person.