A Paradigm Shift Will Fix Health Care

The shift is from a one-size fits all model of providing health care to a unique health assessment and plan for every individual. Trust me, this is big, and until I saw this slideshow prepared by the Ralph Snyderman MD, Chancellor Emeritus of Duke, I hadn’t really thought much about it, although I’ve lived through a great deal of it.

The medical model in the 20th century, according to this theory, was a “one size fits all” model: there’s one cause of a disease, and if we find it, we fix it. This model developed out of the discovery of germs and their role in causing illness. During the last century, we focused on anatomy, physiology, chemistry, physics, and pathology — the tools that helped the doctor find the single cause of the disease. This “find it, fix it” model was reactive, not always effective, and has nearly bankrupted American society at a time when we have an aging population. If we try to treat them all with the reactive model –you come to us with a symptom, we find it, and we fix it– we are often intervening too late. That’s why people complain so much about whether they can get in to see a doctor.

But things have been evolving philosophically. On a very minor level, you can see it with, for example back pain. If you give X-rays to most older people you will see degenerative disc disease.  And yet all older people don’t have pain.  Same thing is true of Alzheimer’s disease. Many people who have no symptoms are autopsied and found to have the disease markers. Here’s another one: we know smoking causes lung cancer, but not everyone who smokes dies of lung cancer. So these diseases are never “found,” and supposedly never “fixed.” Clearly, not everybody responds  to the same “cause” with the same “disease.” (Or at least the same symptoms that require expensive interventions.)

Fortunately for us, we’ve arrived just in time at a different perspective on disease. Because of genomics, proteomics, systems biology, micro-nanoprocessing, and informatics, we can now make a pretty educated guess as to who’s predisposed to get what, and then take steps to prevent it while there’s still time. That’s going to change “find it and fix it” to “predict it and prevent it.” If I were a smoker, and found out I also had the genetic predisposition for cancer, I might be more energized to give up the habit.

The cost savings involved in early intervention have been known for years. But now we’re actually at a moment in time where a doctor can stop practicing “hamster medicine” (which is what they call it when you see 25 patients a day and do little besides triage), and actually begin actually talking to patients who are not yet sick. Each patient could be tested, receive a personalized health assessment and a personal plan based on his or her individual risks.

Under this model, care could be coordinated through a medical “home” for each patient, and we would neither be needlessly exposing every 40-year-old woman to radiation for a mammography, or making blanket rules to deny mammograms to people under 50 just to cut costs. We could offer them to people who can actually benefit from the early detection they provide.

I’m a fan of innovative ways to approach problems, a fan of disruptive technology, and a fan of system thinking. You can imagine how much I like this paradigm shift. It can’t come soon enough for me.