Self-Driving Health

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Lots of news about this recently.  Five years ago, you would shake your head and say “no way – not in my lifetime.”  Now you know that this is our future.  It will be safer, will save billions of dollars, and will be have positive consequences we can barely imagine.  The kids need to go to soccer practice?  Send them.  Get the dog to the vet for his check-up?  Plop him in the car and off he goes. It’s real. It will happen.  Soon.

So why is it so hard for us to imagine self-driving health?  Do we have a crisis of under-supply of primary care?  Yes.  Today we do .  But I wonder if that’s because we’re asking the wrong question.

Not long ago, I heard that we would need 60,000 additional primary care visits in our community to reduce the demand for non-urgent visits in our emergency departments.  If a primary care provider can see 25 patients a day – then we need ten additional providers in our community (250/day = 1250/week = 5000/month = 60,000/year).   But what if those 25 visits that didn’t need an ED visit ALSO didn’t require a primary care visit?  What if “visits” in 8 x 10 exam rooms with white-coated professionals weren’t the solution?  Let’s play the “five why” exercise:

Donald Duck went to the Emergency Department

  1. Why did he go to the emergency department?   Because he didn’t feel well and wanted to feel better.
  2. Why didn’t he feel well?  Because he had a fever and cough and the medicine he bought at CVS didn’t help.
  3. Why did he have a fever?  Why didn’t the medicine he bought help?  Because he had a bad cold – maybe even the flu (didn’t get a flu shot) and wasn’t sure what to buy at CVS.  He bought some kombucha and aspirin.
  4. Why didn’t he get a flu shot?  Because he doesn’t like going to the doctor.  Only goes (to the ED) when he feels sick.
  5. Why doesn’t he like going to the doctor?  Because they never seem to listen to him – and doctors are for sick people anyway.  Why bother?

So what’s going to prevent Donald – and 24 of his friends – from going to the ED?  Is it another doctor with an open appointment?  No.  Education, empathy, caring people – who can help Donald understand what’s available to him to prevent illness, and what’s available to him when he is ill:  a phone call, some good trustworthy advice, and (yes) if necessary – a visit with a care provider. But I’d argue that this is much less frequent than we assume.  Adding 60,000 visits is a short sighted (and impractical) way to solve this problem.  We need to help Donald to find self-driving health:  tools that help navigate, understand his goals, and get him from were he is to where he needs to be.

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  1. Sure, your Donald doesn’t need health insurance either. That’s why he’d rather pay the penalty than Obamacare premiums. But we have an aging population that needs complex, multisymptom health care, and those folks need more hands-on care. And the technology substitutes for remote monitoring are not all they’re cracked up to be. And don’t forget that the current system has primary care now shouldering responsibilities like eliminating obesity. But your point is well taken: Not all health care needs require physician/provider intervention. And not everything our existing physicians are doing is worth the time we spend on it. Other “industries” pay more attention to efficient use of skilled personnel than the healthcare factories of the era we’re living in.