The Crystal Ball 5

“In our last discussion, Curmudge, we talked about Clayton Christensen’s book, The Innovator’s Prescription, and we introduced his concept called disruptive innovation. I see the book as a 441-page Lean exercise. He defines a problem and then develops countermeasures.”

 “Good observation, Jaded Julie. The problem is that ‘the growth in health care spending in the United States regularly outpaces the growth of the overall economy.’ The insights of Christensen and his coauthors provide the basis for some mighty convincing countermeasures. Christensen even provides biblical justification for his efforts, ‘Where there is no vision, the people perish.’ (Proverbs 29:18)”

“Wow! This sounds ominous, and we’ve only written two paragraphs. Speaking of writing, we must remind our readers that what appear to be our statements and conclusions are actually the paraphrased or quoted words of Christensen and coauthors.”

“Here’s the thrust of Christensen’s thinking. While much of today’s political dialogue is focused on how to pay for increasingly expensive health care in the future, this book is aimed at reducing costs and improving health care’s future quality and accessibility.”

“As we explained last time, the first step in disruptive innovation is the development of sophisticated technology that simplifies. Shall we start with that?”

“We shall, and let’s consider how technology impacts diagnosis, the first step in one’s visit to the doctor. The human body’s vocabulary is pretty limited in telling us what’s wrong with it. Because there are many more diseases than there are symptoms, many symptoms have to be shared. If a man went to the doctor complaining of a headache, the symptom could indicate a problem ranging from a brain tumor to having too much to drink the night before. Many years ago the diagnosis would have totally depended on the doctor’s experience, intuition, and acquaintance with the patient. This is called intuitive medicine, which leads to trial-and-error therapies with the hope of mitigating the symptoms. Now, modern imaging techniques would take a lot of guesswork out of the diagnosis. As Christensen states, ‘the technological enabler for disruption in health care is the ability to diagnose precisely, which then opens the door for a predictably effective therapy.’ “

“Curmudge, we’ve certainly progressed in the diagnosis of infectious diseases. Identification of the microorganism in a throat culture will allow selection of an antibiotic to wipe out a strep throat pretty predictably.”

“That’s called precision medicine, Jaded Julie. It is ‘the provision of care for diseases that can be precisely diagnosed, whose causes are understood, and which consequently can be treated with rules-based therapies that are predictably effective.’ ”

“It would be really great if we could use this precision medicine for everything. Not only would the patient be cured, but it would cost less than trying this and that therapy with the hope that the symptoms would subside. I presume, Curmudge, that more definitive diagnoses will be matched by development of more directed therapies.”

“That’s the other half of the story, Julie. Recall our stating that the body can’t express enough gross symptoms to tell us what’s wrong? If fact, the body is quite articulate in terms of genetic expression. Although we wish there were more, there are a few specific molecular tests that can identify certain cancers quite specifically. These tests can be teamed with pharmacogenomics, a new branch of pharmacology that aims to develop rational means to optimize drug therapy, with respect to the patient’s genotype, to ensure maximum efficacy with minimal adverse effects. Of course, we’re looking a bit into the future for this kind of personalized therapy."

“Yes, but we already have a name for it. It’s called ‘Personalized Care.’ So how will these changes affect the practice of medicine?”

“We’ve seen examples of how many diagnoses will become more specific and less intuitive and therapies will be more precise and less trial-and-error. Retail clinics staffed by nurse practitioners already diagnose and treat lists of illnesses and conditions, and the lists will undoubtedly expand. Their diagnoses are straightforward, and their therapies are evidence based. One might expect that they will disrupt the primary care physicians, but because of the clinics’ speed, convenience, and affordability, Christensen feels that they compete predominantly against nonconsumption. For a variety of reasons, their patients would skip their vaccinations and tolerate their illnesses until they went away or became serious.”

“Our earlier postings on Information at Your Fingertips and Amazing Devices foretell big changes in the primary care physician’s office. Christensen suggests three innovations that will move primary care docs into the realm of specialists: (1) analytical and imaging capabilities at the point of care, (2) online decision tools, expert system software, and algorithms that guide diagnosis, and (3) telemedicine (remote consultation with an expert).”

“And what about the specialists?”

"They are likely to disrupt one another. Cardiologists doing angioplasty have been disrupting cardiac surgeons for years. Interventional radiologists are disrupting surgeons by their instruments’ enhanced ability to visualize the area requiring surgery.”

“Golly, Curmudge, with a surgical robot even I could perform surgery. So how might these big changes impact the hospitals?”

“Hang in there, Julie. We’ll talk about hospitals next time.”

Affinity’s Kaizen Curmudgeon.