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The Future of Medicine

Updated: Feb 28, 2022

Energy II. Watercolor on paper. Discovery Bay, Hong Kong. April 2020.

We tend to think of the future of medicine as being driven by amazing technology breakthroughs, like unraveling ways that stem cells will allow us to reverse chronic degenerative problems or figuring out fixes by manipulating the genome.

But actually, it’s already here

The reality is that the future of medicine is already here. It feels more messy than the clean and orderly future portrayed in sci fi movies, but perhaps a bit less dystopian.

Just for example, look at COVID reporting on the media. There is too much information that is often conflicting. As a doctor it feels time consuming and a little overwhelming to keep track of all the different vaccine options - I can only imagine what it must be like for lay people to be told they must understand what mRNA is.

Health services were already trending in the direction of depersonalized care and too much technology, but the pandemic has accelerated the transition to remote consultation, and testing and vaccination services have been farmed out beyond our usual care settings into stadiums and even parking lots.

Care systems are difficult to navigate and it’s hard to know whom to trust. How are we supposed to know if we are making the right decisions? Not wasting time and money?

GPs are dinosaurs

When I went through primary care training as a general internal medicine doctor in the early 1990s, we were hailed as the saviors of medicine. The US healthcare system was too expensive, with too many specialists and rampant abuse of insurance used to pay for unnecessary procedures.

At the end of day, no one else can take care of ourselves, but us.

Primary care providers (aka PCPs) were to be the gatekeepers for care, adjudicating the medical necessity of everything from this MRI to that heartburn prescription. Well it turned out that people didn’t like that kind of policing, and doctors didn’t like being policemen so now we have more specialists than ever.

In Hong Kong, private practice has pretty much stayed in the “good old days” model where doctors charge fee-for-service and patients pay with their credit cards at the point of service, claiming from insurance afterwards. PCPs are called general practitioners or GPs here, and people love the service model so much that I have patients returning to Hong Kong from all over the world just to get their care here.

Fig 1- Current model of GP services (shaded green) and patient responsibilities (shaded pink).

The problem is that it’s not sustainable.

Quite aside from the political drama that has been unfolding in Hong Kong over the past 2 years, the GP model has been slowly fading away the world over for a reason. The bottom line comes down to funding as usual.

What’s next?

We have historically loved the idea of having a family doctor who is always available and whom you can trust to look after you, from urgent care to hospitalizations to physicals. But the reality is that the future of medicine looks very different. No matter where you live in the world, these services can already be found in many settings outside of the primary care office. (See Fig 1)

Fig 2 - New paradigm of care. Self care is central to optimal health (yellow) practitioners to support (green).

GPs have been uniquely positioned to provide continuity and preventive services, as well as referrals to specialist networks. But as technology advances and health systems seek to reduce costs further, GPs are going the way of travel agents and bank tellers.

And this forces us to each take ownership of our own health. Which is actually a good thing. Because at the end of day, we have to ultimately be responsible for what food we eat, how many hours we sleep, and how much exercise we get. No one else can take care of ourselves, but us. (Fig 2). Doctors and other care providers are peripheral.


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