As we pursue our goal of minimally disruptive medicine, we need to have an eye on how we are going to recognize when we get ‘there’.
What does it feel for a patient with multiple medical conditions to experience healthcare that fits? By fit we mean healthcare that pursues the goals of the patients in manners that are consistent with her preferences while demanding work, time, and attention that can easily be integrated with all the other roles the patient plays in their lives: mother, sister, wife, worker, friend, etc.
For some it means technologies that are placed at the ‘point of life’, i.e., at home, at work, in between. These technologies, ubiquitous technologies, can monitor signs of health and disease and use of treatment and communicate this information to algorithms and caregivers who in turn act on this information to deploy a tailored treatment. This treatment (which could be advice, support, education, or medicines) accesses the patient with minimal requirements from the patient and acts on the patient with minimal to no involvement or at times of the patient choosing.
There is out there the belief that patients with chronic conditions need to be aware of their disease in order to manage the disease effectively. Putting the condition and the necessary treatments in the back burner without due attention leads to disease progression and loss of health (so-called denial state). But what if treatments just worked without calling attention from the patient? Will this be progress? What do the “personal responsibility” crowd feel about such development?
What are the implications for diagnostics and monitoring? Can these take place in ways that do not require patients to act on them to activate or submit for analyses? What are the implications for treatment design? What are the implications for direct patient examination (make an appointment and meet with the clinician taking time away — in time and space — from usual routines)? What role may indirect patient examinations (asynchronous? at the point of life? without patient participation?) play?
In the minimally disruptive medicine utopia, are patients allowed to forget they have multiple chronic conditions? If so, what happens with the behaviors and actions, the ways in which the patient interacts with the environment, that are necessary to prevent further progression of these conditions or the appearance of new ones? Isn’t being sick a motivator to avoid getting sicker? If treatments become “not a big a deal”, will individuals loose the motivation to prevent chronic disease?
We welcome your wildest dreams and most careful consideration. What does a life of chronic disease looks like when treatments just fit?