I long for the simple days of medical care, when the doctor smiled and said “don’t worry, you’ll be fine in a few days”. Or, at the other end of the spectrum “put your affairs in order”. While this second option would be unwelcome, it is a definitive message. I’d prefer no dithering about, ordering endless tests and unpleasant invasions into internal spaces where no metal thing has gone before.
When I was young and full of thoughts of saving the world, I embarked on a career path that involved curing cancer i.e. doing a PhD to learn research methods for finding new treatments. At the time, there was considerable money available for cancer research, thanks to Terry Fox, and a war on cancer fought by various celebrities. Fast forward 40ish years, even though loads of progress has been made understanding the disease and incrementally improving treatment outcomes, we are now at “living with cancer”.
Who the hell wants to live with cancer? Yuck. From my experience, it means living with medical tests every week, going month to month to hear whether the tumour has progressed, regressed or spread. And after more harrowing tests, learning of unpleasant (taking into consideration side effects) treatment options.
This is no way to live. It’s a way to half live, which many would argue is better than being completely dead. I’m not so sure, although I’m speaking from my healthy and able perspective. That said, there is a reason society is accepting MAID.
Ok, rant over. I’m disappointed with the progress I see in modern medicine, which often amounts to more efficient ways of doing what we already know how to do.
I was hoping for more progress in treating diseases, meaning with less invasion, fewer inconclusive tests, more humane treatments and cures. My perception of recent advances is automated care, so that your gynecologist has the data from your physiotherapist who both know your hemaocrit, even though neither is likely to find this useful, etc. You can book an appointment online, although none of my doctors do this, share your data limitlessly with family, friends, professionals and unintentionally, ne’er-do-wells.
What I’d really like from medicine isn’t possible, because it isn’t possible to cure the body of naturally declining and dying. I was astonished to find the dictionary definition of dying from what we used to call ‘natural causes’. Unless there is trauma, the progressive decline of body function is natural. This progressive decline is what modern medicine calls diabetes, thyroid problems, cardiovascular disease and even cancer.
Medicine has stolen natural processes, sticking it’s nose in and deeming to manage them in a way that looks like there might be a cure if it’s treated just right. Ok, medicine doesn’t claim to cure, but manages diseases with a bunch of awkward measures to slow the natural course of decay. Generally, this doesn’t make anyone’s life easier, just longer, although, much of that time may be spent in a doctor’s waiting room. This may be the entire plan: people perceive their lives are longer because it seems like forever waiting to be called to a 5 minute consultation on a recent blood test that shows everything is ok but needs to be tested again in a month.
I am glad for all of the people who have been spared colorectal cancer because they had a colonoscopy and polyps removed. The declining rate of colorectal cancer suggests progress is being made. But can’t find a less invasive way to do this, than messing with people’s digestion for several days, requiring a hospital visit, and sticking at least 6 feet of metal tubing where the sun don’t shine? I imagine that in 100 years, our approaches to medical diagnostics will look as sophisticated as leeches and blood-letting of centuries ago.
Meanwhile, back in innovation, wonderful advances are being made in the efficiency of diagnosis. AI is being shown to improve the accuracy of diagnosis, from reading pathology slides, X-rays, to cross referencing symptoms and other data. Automated systems can improve the patient experience in the waiting room, or ideally, get them out of the waiting room. Patient information is being shared at an amazing rate, which will improve medical care.
What concerns me is that much of recent innovation is directed towards making the medical system stream full ahead into the waters of ongoing appointments, more tests, more definitive diagnoses of diseases or situation there is no cure for. It’s all well and good if I can get an MRI by booking online the minute after my doctor orders it, and then have it interpreted by pathology, location, stage and prognosis immediately after the scan, only to learn there is no treatment. It’s like fast-tracking the repainting of a car, even if it has no wheels.
Yes, but finding cures is hard and bringing new treatments to market is intensely costly compared to a new office management system. Time to think about creative destruction. A whole new approach to medicine, that looks nothing like our current way.
I’d like to revolutionize primary medical care – the stuff a family doctor provides. Turn the emphasis from monitoring and managing indicators of lack-of-health and disease to enabling the maximum amount of enjoyment and freedom for every person.