Medical breakthroughs can be sexy. They can also distract us from life-saving, low-hanging fruit.
A new drug often makes waves in the headlines and the stock market when it’s shown to improve relevant outcomes. Somehow it’s not quite as newsworthy when remission rates increase from 55% to 68% in kids with Crohn’s disease… if it happens simply by improved communication among doctors. I believe more improvements in healthcare in the coming years will come from this kind of “systems thinking” than from traditional drug development.
To be sure, it’s easier to focus on improving one piece of the system, and financial incentives are stronger for developing a drug that works in an artificially constrained context, than for making un-patentable improvements to the way we deliver care.
But we’re starting to see just how sexy the opportunities can be. Atul Gawande has millions of fans savoring his stories about interventions as mundane as using checklists to make sure the surgeon, nurse, and anesthesiologist talk to each other before starting surgery.
It’s daunting — and exciting — that the many systems we depend on for health care are so complex, it’s almost silly to focus on point solutions. Even more exciting is that patients are not only part of the system, but that they can and must be part of the solution. A simple and delightful example: when Sweden’s emergency response services saw they didn’t have the manpower to provide prompt CPR to all cardiac emergencies, they invited lay people trained in CPR to respond to emergency calls. Which was more brilliant: the simple design of the system which sends a text message to all CPR-trained volunteers within 500 meters of the emergency, or the cultural innovation that allows non-experts to help?
Why is it so hard for a system designed to be about knowledge flowing from scientists and physicians to patients, to evolve into a more collaborative one? Perhaps Machiavelli explains it best: “It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders in those who gain by the new ones.”
More simply, change sucks, especially for those who have (and like) power. But change is in the air, and I think it’s because we’re seeing beautiful things happen if improvements are allowed to come from non-experts. Not only might a patient-driven improvement be a good one, but the fact it originates from the patient can start a virtuous cycle of self-efficacy.
Psychology aside, it’s a no-brainer that we need to let patients help. There are countless smart ones who are able and willing to help us take better care of them — take better care of each other. And once the ideas start flowing, next thing you know we’ll have doormen in Manhattan volunteering to help keep the elderly living safely and independently. That’s sexy.