Collective wisdom

As public consciousness and knowledge about health issues grows, thanks to the internet and other media, I predict that:

1) Hospitals will recede into a role of acute and catastrophic care ONLY, dropping the charade of providing health, which they do NOT.

2) Doctors and other health professionals will begin to see themselves as providers of acute and catastrophic care, also. They will stop providing day to day care, such as treating high blood pressure, cholesterol, breast exams, and other preventive maintenance.

3) Instead, preventive care will be self-provided. The public will have acquired sufficient savvy and know-how to manage issues like blood pressure themselves. They will need the assistance of helpful information resources, web-based for the most part. Much preventive care can, in fact, be algorithm-driven, just like following a simple recipe.

All the worries about runaway health care costs will be much reduced, since excessive testing driven by liability worries will disappear, repeated office visits for day-to-day issues will go away. Yes, you will need a doctor and hospital for a broken leg, car accident, unexpected cancer, or non-compliance or neglect of prevention.

But osteoporosis, high blood pressure, nutrition, weight loss, hormone management, cholesterol issues, minor complaints will all be managed by people themselves with the assistance of web-based knowledge systems.

I already sense this sort of phenomeonon developing, though in its infancy, in venues like the Track Your Plaque Forum and other health portals, places where the information being discussed exceeds the quality of information you can obtain from your doctor. Over and over again, for instance, the sophistication and knowledge demonstrated by our Track Your Plaque Forum discussions shows that the public is capable of far more understanding of health issues than many previously believed. Most of our members could carry on a credible conversation with trained lipid experts. The knowledge base of our members exceeds that of 98% of most of my colleagues when it comes to heart scans, lipoproteins, and nutrition.

I am in awe of Wikipedia, the popular online encyclopedia. Five 20- and 30-somethings have created a knowledge base that has now eclipsed Encyclopedia Britannica in size and scope, with equivalent accuracy, and relatively little cost. I'd like to see the same phenomenon occur in health care information, helping to usurp the current paternalistic "I'll tell you what to do" model.

Comments (5) -

  • wccaguy

    10/13/2007 2:14:00 AM |

    Hey Doc,

    A terrific vision to strive to make happen.

    One problem is...  How are we supposed to rollback the control that doctors have over key elements of our own preventative health programs if all them are devoted to crisis management.

    The intersections Doctors currently control include at least the following

    1) ordering blood tests,

    2) ordering CTAs when required

    3) delivery of CT calcium score scan info to doctors (I've been told no doctor is required to get a CT scan.  Is that true?

    4) prescribing drugs like statins in situations that aren't emergencies but still critical.

    Moreover, if a doctor's approval is necessary to get reimbursement for these more costly tests, how is interfacing with the doctor avoided?


  • Gary Greenfield

    10/13/2007 9:17:00 AM |

    I recently came across your blog and I greatly appreciate and agree with what I have read thus far.  It is indeed refreshing to cross paths with an allopathic physician whose views  run contrary to popular brainwashed opinion. It seems as though our culture has removed God from His rightful place in society and replaced Him with physicians.  The average patient today is willing to pay any cost for treatment to prolong his life and hospitals are willing to allow no ceiling on costs to save a life.  In the meantime, what price is a man willing to pay to save his soul and what price are hospitals, (once religious institutions) willing to pay to address the salvation of the soul?  I'm afraid the tables have turned and what you are observing  and writing about is a direct consequence of this delema.

  • jpatti

    10/13/2007 6:44:00 PM |

    It won't happen like this.  

    Sure, motivated patients will largely provide their own health care and manage it themselves.  I just bought an endocrinology textbook and ordered some lab work before coming to your blog today.  But I am not most people; most patients are not motivated.

    There are 6 diabetics in my family.  I'm the only one willing to give up *sugar* let alone wheat and other problematic grains.  I've given copies of Bernstein's book to them, made homemade sugar-free chocolate, etc.  This has almost no impact on their life choices.

    I've sat and listened to my husband's stepmother talk about how much her feet hurt WHILE eating cookies and cake.  I don't choose to be a nag, and have already provided the necessary information, so there's nothing to do for her but sit and listen and be sympathetic.

    This is the reality of the vast majority of patients: they do what they want to do and count on their doctors to fix them.  

    Heart disease is very similar to diabetes, 99% of the outcome is in the patient's hands.  Doctors can't actually do much to effect the course of the disease other than provide recommendations.  

    The doctors you criticize for not empowering their patients have an awful lot of stupid patients too.  Some of these patients *deserve* some of these doctors.

  • Dr. Davis

    10/14/2007 1:41:00 PM |

    Yes, unfortunately, there is a substantial segment of the American population who will never mind their own health. But the "bell curve" will shift to the right over the next 50 years. I don't have illusions that this will happen next week. This is a evolutionary process that will affect our children more than us. But it needs to happen.

  • Dr. Davis

    10/16/2007 10:51:00 PM |

    I think the path to self-empowerment will require decades and come from a variety of changes, such as increasing availability of direct-to-consumer laboratory testing; reduced price barriers for imaging tests; more medications transferred into over-the-counter status; more info and more powerful nutritional supplements. Also, the growth of medical savings accounts and similar tools that allow self-directed health care purchasing will introduce greater consumer choice into the equation. But it will evolve over time.