Came across this article, a thoughtful and balanced argument in favor of “Personalized Medicine,” in other words treatment customized to the individual. The author emphasizes the role of genetic testing, which is an established practice for cancer chemotherapy, and an emerging discipline elsewhere. But there are other aspects to personalization, among them (as the author notes) the particular range of symptoms a patient might express, a combination that is unique to each individual. Herbalists might add intangibles like temperament. Someone with an economic viewpoint like myself might add assessment of risk tolerance, which is different for different people.
I’ve had the pleasure of working with medical and nursing students lately, and I can assure you, they believe in the personalized approach. Unfortunately, they are entering a field that is increasingly becoming depersonalized. This depersonalization is being driven by a combination of technology and policy.
Of each business firm, ask, what is it, in itself? What is it, essentially? For example, BMW doesn’t “make cars,” they sub that out. BMW is a design and marketing firm, essentially. Google is a marketing firm, essentially; search engines and email apps are just how it gets there. Etc.
A healthcare firm is, in essence, a mechanism for moving data around. Data is collected, and transferred to an insurer, who moves money (a form of information) from one account to another.
This is a bit hard to see from my perspective. I labor under the idea that my job is to make a diagnosis. Which isn’t as easy as it sounds; there’s often a lot of detective work involved. Yet I’m told my actual job description is to enter data, enter a specific kind of data, and please try not to waste time in the meanwhile with trivialities like talking to the patient. Which distracts from the firm’s mission. “We don’t pay you to talk” has, in the era of telemedicine, evolved into “We don’t pay you to examine the patient.” Healthcare itself is evolving into a stimulus-response paradigm. Can’t sleep? Rx sleeping pill. Ear ache? Rx ear drops. Had a seizure? Rx anti-seizure medicine. Depressed? Rx antidepressant. All they need from me is the “review of systems” (approximately 100 questions that, by definition, have nothing to do with the patient’s concerns) and a signature.
Healthcare firms lack a unity of purpose that you don’t encounter at a firm like Tesla, where everyone involved understands the mission (to build cars.) In health care, we seem to disagree on the nature of the final product. What do we produce? A well patient? Or a billable encounter? Healthcare technology strongly favors the latter, making billing and compliance quite efficient, at the expense of patient care.
To put a finer point on it: in other words, the question is, what matters most? Process, or outcomes? Unfortunately, process has been winning lately.
The author is right. Yeah, she’s re-inventing the wheel somewhat. But, somebody has to.