Ten predictions on how medicine will change in coming decades (Part 1)

Speaking on the role of technology in health care at a conference in Boston recently, Susannah Fox, the chief technology officer of the U.S. Department of Health and Human Services, said, “We’re living through this time right now where technology is a Trojan Horse for change. We say technology, but we mean innovation. We say interoperability and open data, but we mean culture change … I know about culture change. I know how difficult it is for everyone involved.”

She’s right. The internet and social media have accelerated patients’ and doctors’ ability to organize and share ideas about how to fix what’s wrong in our health care system.

While innovation will certainly bring about some permanent changes in health care, current trends may also create some unwelcome developments. Here, in no particular order, are my first five of 10 predictions on the future of medicine over the next couple decades.

1. A two-tiered system of medical care will emerge. In England, everyone can access the National Health Service (NHS) for medical care, but long waits for surgeries abound and patients express frustration with the difficulty of getting referrals, especially to mental health specialists. Treatment can be delayed.

In the UK, wealthier individuals purchase private insurance in order to choose their doctors and get their procedures done more quickly. Already, concierge medical practices, which charge a yearly access fee, result in more attention and office time for those patients who can afford it. Sometimes, extra time means fewer diagnostic errors and false starts with the wrong medications.

In the U.S., most of us will be restricted to our health insurance plan, with its limited choice of doctors and hospitals, while the wealthy will purchase supplemental health insurance plans or pay cash for concierge services.

2. Fewer of the best and brightest will enter medicine to be doctors. The past year has seen increased reporting about medical students who are using medical school as a stepping-stone to enter the startup world without needing to learn software development. And why not? Startup employees can get rich quickly, don’t have to pay their dues for a fixed number of years before getting recognition, and are considered high on the list of enviable career tracks. Doing rectal exams and going without food during 16-hour surgeries pales in comparison.

For those students who attended state schools, taxpayers partly covered their medical education. Yet, those taxpayers will receive fewer practicing physicians than in years past, simply because the allure of startups and hedge funds is too strong for many graduates.

Some exceptional students will still do residency training to enter higher-income specialties, like orthopedic surgery or plastic surgery, but there's a chance that most of the future physicians who practice in the community won’t be as exceptional. This has implications for leadership in medicine. The most motivated and high-quality physicians are often the ones who lead in health policy and medical research, and we cannot afford to constantly lose our best talent to non-medical jobs.

3. Hospitalizations will plummet. The threshold for getting admitted to the hospital from the ER or from the doctor’s office is incredibly low. Kidney infection? Hospital. A few too many potato chips in a heart failure patient? Hospital.

The problem is that hospitalization is amazingly expensive. The average California hospital costs more than $3,000 a day, money that gets paid by patients and insurers and results in higher premiums the next year for employers and patients. Many of these hospitalizations can be prevented. Medical monitoring devices and better access to primary care will allow doctors to monitor patients. Illnesses will probably clear up more quickly outside of the hospital environment, and health care-associated infections should drop as well.

4. Cancer screening will increase. While cancer screening still isn’t at target levels, according to the CDC, several factors should change that. First, as patients find doctors through the Affordable Care Act’s expansion of coverage and finally schedule those first appointments, there will be many mammograms and colonoscopies occurring that hadn’t been done for many years. Second, cancer awareness will increase, since more people are living longer with cancer. Their presence in communities will be a constant reminder that cancer doesn’t discriminate.

5. Finding a doctor who prescribes high-dose opiate pain medications will be difficult. Already, physicians are blogging about “Why I stopped prescribing narcotics, and never looked back.” Doctors, pressed for time and terrified of murder convictions in overdose cases, are banning the drugs because they require more work. That includes screening for depression, rating pain on a scale of one to 10, talking down patients who want to jump right to the highest potency medication, and trying to detect when people are just getting the meds to sell them.

This will be a hot-button issue in the coming years, as the number of elderly patients living with crippling arthritis and other painful conditions like cancer will only increase with the aging of the baby boomer generation.

[Photo by Roberto D'Angelo via Flickr.]