Dr Nitin P Ghonge, Senior Consultant Radiologist and Academic Coordinator – Department of Radiology, Indraprastha Apollo Hospital, shares his thoughts on the lessons learnt from the current COVID-19 challenge that are likely to have significant impact on the subsequent evolution of healthcare across the globe
The ongoing outbreak of novel corona virus (COVID-19) has created an unprecedented multi-dimensional global crisis. Surely, the present pandemic of novel corona virus will have significant short- term and long-term impact on healthcare. We expect a change in the priorities of policymakers and the way healthcare systems will evolve in the years to come. The lessons learnt from the current challenge are likely to have significant impact on the subsequent evolution of healthcare across the globe.
Greater sync with nature
The future growth of healthcare should establish a cordial sync with the nature without fiddling with the basic laws of the nature. As Leonardo da Vinci has said, “Vitality and beauty are gifts of nature for those who live according to its laws.” The primary objective of healthcare should be to ensure health and happiness for the individuals. Conservative approach and evidence-based practice becomes much more relevant. Patient-centric approach, problem-solving attitude and sync with nature should be the key for further evolution of healthcare.
Rise of evidence-based Lifestyle Medicine [eLSM].
Non-communicable diseases are the predominant cause of burden over the healthcare in last several decades. This is high time, when we need to understand the importance of disease prevention, based on lifestyle modifications. Evidence-based approach is crucial for the rise of lifestyle medicine. Clinical Radiology is likely to serve as backbone for lifestyle medicine. Healthcare may gradually subdivide into two broad categories: immediate/short-term measures and long-term measures. The first set of measures may predominantly include medical or surgical interventions, while long-term measures will predominantly include the lifestyle modifications.
Multi-disciplinary ‘diagnosis-based’ clinical triage
Multi-disciplinary assessment at the initial presentation should be the only way forward for an efficient triage system which would include general physician/ER specialist, clinical radiologist and laboratory specialists. Accordingly, the patient is referred to the relevant department for the specialist care and treatment.
At present, the specialist-driven healthcare is the standard in global medical practice which often raises concerns about the problems of over-specialisation in medicine. The inappropriate specialist referrals often lead to treatment delays, increased cost and confusion for the patients. As human body is a complex anatomical and functional entity with integration of organ systems, disease diagnosis always requires a comprehensive multi-specialty approach. Clinical radiologists are therefore in the best position to perform primary care triaging. Clinical radiologists who ‘specialise in not specialising’ are likely to play key role in future healthcare.
Precision Medicine and Artificial Intelligence will become more than buzzwords
Precision medicine is “an approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person.” Imaging sciences are likely to play crucial role by virtue of early disease detection, monitoring and image-guided targeted therapies with use of anatomical, functional and molecular imaging and integration of data. With advent of artificial intelligence (AI) tools, the roles of radiologists will expand further as a comprehensive service-provider. I am sure that ‘AI-enabled radiologist’ will soon replace radiologist of the past. Precision medicine and artificial intelligence will become much more than buzzwords and will be integrated in the clinical practice much faster in the post-COVID era.
Restructuring of the healthcare dynamics: Volume-based to value-based
Several decades earlier, medical service has entered the era of corporate healthcare where patient is simply a number. Dr Richard Reece, an internal medicine specialist aptly described the state of affairs. “Once upon a time there was a profession called medicine. Now, there is an industry called healthcare.” As expected in an industry, performances are calculated in numbers and end-point shifts from patient’s wellbeing to monetary gains. The ‘volume-based’ business model of healthcare is the worst thing which happened to medicine and certainly need to be addressed.
Post-COVID evolution of healthcare including radiology should move from ‘volume-based’ to ‘value-based’ approach in the interest of patient. The ‘efficiency’ of radiology services should not only be measured in terms of numbers, but also on the quality of impact on patients’ well-being. These radical changes will only be possible with complete restructuring of the healthcare system including realignment of business model and the leadership.
Time to regain respect for doctors and to rebuild trust in healthcare
It is important to realize that the stature of doctor in the society has gradually declined in last few decades. High treatment costs, lack of personalized approach, sub-optimal communication, inadequate counselling and unrealistic expectations from the medical sciences are few of the key reasons for overall decline in society’s trust in healthcare. The present crisis is the golden opportunity to rebuild this trust and regain the same old respect as healer for the humanity. The doctor-patient relationship and the healthcare equations should go back to basics. A good doctor needs to strike a balance between the preferential conservative and selective aggressive approach, depending upon clinical presentation, patient preferences, clinical acumen and scientific evidence. It is important to avoid undue panic over physiological processes like osteoporosis or altered physiological state like irritable bowel syndrome. This watchful waiting should certainly be backed by scientific evidence in the form of clinical presentation, imaging studies and laboratory investigations.
COVID-19 crisis has bluntly taught us few basic laws of our existence on this planet. Despite all the scientific advancement in modern medicine, we human are only ‘lesser mortals’ and are exposed to the continuum of inevitable aging and death. Darwin’s theory of ‘survival of the fittest’ and mechanism of ‘natural selection’ will continue to govern our survival. It is important to accept that even the biggest doctors or costliest of healthcare systems cannot challenge these laws. Money can certainly buy healthcare but money cannot buy health!
Every story has an end, but in life every end is a new beginning…
With huge hopes that the dust soon settles over the ongoing rage of COVID-19 pandemic and the world is back to all its glory and amidst concerns of bringing back the normalcy, it is important to understand that there will be new ‘normals.’ The cycle of life always brings new normals by virtue of change. We need to learn the lessons and accordingly work towards a better healthcare for future. Healthcare in the post-COVID era seems to evolve and expand new horizons for radiology.
We shall overcome…
Great article Sir.
I, as a radiologist, would love to be AI enabled or to be part of precision imaging. Would you be able to enlighten us on the path to do so?
Clinical work with AI integrated tools will only pave way for Precision Medicine. Most of the hospitals in India still don’t have this infrastructure. At individual level, one should be able to understand this integration of structural and functional imaging. Multimodality skills and problem solving attitude are essential traits of good Clinical Radiologist to create positive impact on human lives.
Very nicely annalised sir…However there is one controversy I feel…covid19 unfortunately is erasing art of clinical examination under name of distancing ….And again people will have rat race of number to balance losses ….
Selfish motives will always lead to number game and the unhealthy rat race in healthcare. Hopefully, the healthcare evolution in the post-COVID era will be predominantly based on the conservative approach and evidence-based lifestyle modifications. With unrealistic expectations from healthcare, patients often become restless and expect instant diagnosis and prompt treatment. As patients understand the importance of lifestyle choices as a determinant of individual health, they may not prefer instant symptom-based treatment options and may ask for treatment options to address the root cause. Healthcare services need to modify in concordance with the patient expectations, which may now change gradually.
Government should take utmost care in maternity, everything related to pregnancy care and dedicated pregnancy care and maternity hospitals are more safer than choosing a multiplicity hospitals during the outbreak of pandemic.
Yes! We will overcome. We have to work hard towards a better healthcare for future. Doctors Hospital will strive to improve the quality of life by providing best doctors and staffs.