The Future of Healthcare

The most recent advance in technology that everyone has been talking about lately has been AI. There are many uses for AI in the medical field but the one that affects me most in my day to day work is the recent advent of AI “scribes”. Doctors used to handwrite their notes, then they would dictate them and send them out to be transcribed, then voice recognition came along, and most recently AI scribes have come to the forefront. AI scribes are programs that are often on doctors’ cell phones that are listening to the interaction between the patient and the doctor and then formulating an office note in the format that a physician would write. It leaves out extraneous information such as when the doctor and patient are talking socially. It then formulates a list of the patient’s problems. These scribes definitely make physicians more efficient but there are definite drawbacks as well. The physician has to be extremely careful that they are the ones making the medical decisions and not just relying on AI because it is more efficient.  I am also concerned about medical students who are not learning to reason on their own and instead simply typing in some symptoms into Claud or chatgpt  and coming out with a huge list of possible diagnoses. One of the important skills that medical students need to learn is how to analyze an individual patient’s symptoms and then come up with a differential diagnosis and then narrow down the possibilities by asking the patients questions, examining him or her, and then doing research. One cannot become a good diagnostician by simply asking AI to diagnose a patient; only years of experience create an outstanding physician.

The physician-patient relationship is changing as well. Healthcare used to be paternalistic-the patient went to see their physician for a problem and the physician told them what the diagnosis was and what the subsequent treatment would be with little if any discussion. The patient generally didn’t question the doctor who was considered to be the authority figure. However, with the introduction of the internet in the 1990’s patients could educate themselves on their diagnosis and began to ask questions of their doctor. This provided doctors with an opportunity to share information with patients and thus the doctor and patient worked together to formulate the best plan of care for that particular patient. Treatment finally felt personalized to the patient. It also allowed patients with rare diseases to interact with and get support from others who shared the same diagnosis. Unfortunately, though, a lot of information online and spread throughout the internet that is inaccurate and can sometimes be harmful, so it is important to find a doctor that you feel comfortable sharing your questions and online research with and whose judgment you can  trust.

The providers of healthcare are also changing. There has been a worsening shortage of primary care doctors (primary care encompasses Family Medicine, Internal Medicine, and Pediatrics) due to significant decreases in insurance reimbursement of primary care physicians, physician burnout, and the increasingly aging population. There has been a rise in the number of health care extenders (nurse practitioners and physician assistants) to fill this gap. There is, however,  a large difference in the length and depth of education between physicians and physician extenders. In today’s often rushed medical appointments, a patient often does not know if the person treating them is a doctor or not as we all wear white coats. I believe that patients should be asked if they prefer seeing a doctor or a health care extender each time they schedule an appointment. 

And finally, the delivery of medicine is changing. When I applied to medical school I wanted to be like the Family doctor of my grandparents’ generation who knew all of their patients very well and who treated many members of the entire family. However, when I graduated from residency, most new primary care doctors got a job working for a group practice that sooner or later got bought out by a large hospital system. Doctors are now expected to see patients every 10 to 15 minutes and see at least 25-30 patients per day. Physicians are now employees and the CEO’s are telling doctors how to practice medicine while insurance companies are limiting treatment options and requiring doctors to do time consuming preauthorizations to try to justify what medications they use. Physicians are now just a cog in the corporate wheel.  

Fortunately, some physicians, including myself, have become part of a national movement to bring medical care back to the basics, making the doctor-patient relationship the forefront of medicine. These physicians, especially those in primary care, are leaving the security of being a paid employee to becoming entrepreneurs and establishing their own small practices where they can practice medicine the way they were trained, where medical care revolves around the physician-patient relationship, and decision making is shared and not dependent on external sources such as gaining approval from insurance companies or upper management. This new movement is called direct primary care or DPC.

A few years ago I was introduced to this new way of practicing medicine, direct primary care, and it has become the solution to many problems within the medical field. This model of healthcare is simple and yet works well. Patients pay a reasonable monthly subscription and all of their primary care visits are included. Patients are also able to reach out to their physician via phone calls, texting, emailing, and telemedicine appointments. Since our offices are small, usually consisting of a physician and one or two employees, it is run efficiently and costs are contained. Since there is low overhead, patient panels average around 400 patients compared to 2000-3000 patients in the world of corporate medicine.  Since patients see the same physician every time and know that he or she is readily available, there is an inherent trust in the relationship. There is excellent continuity of care and doctors get to know patients' individual health care goals and can work with them to improve and maintain their health. Appointments are unrushed and a patient leaves the office knowing that all of their needs and questions have been met and they are confident that their prescriptions will be called in and referrals made in a timely fashion.  To cover emergency and hospitalizations, patients in direct primary care practices often have high deductible health insurance or less expensive catastrophic insurance to fill in the gap. 

In conclusion, although the future of healthcare is always evolving, two main changes that affect the future of healthcare are advances in technology like AI and changes in not only how healthcare is delivered but who it is delivered by.