Amazing Developments in Medicine Provide New Challenges
Dr. Peter Cotton is Professor of Medicine at the Digestive Disease Center at the Medical University of South Carolina (MUSC) in Charleston. He founded the multi-disciplinary Center in 1994, which has been repeatedly recognized since then as one of the top programs for Digestive Disorders in the country. It is dedicated to “patient-friendly care and the research and education needed to improve it.” In this article, Dr. Cotton reflects upon the changes that he’s seen in healthcare during his time in the field, and explores the new challenges that face healthcare professionals as new technology, a renewed focus on the patient experience, more effective medications and treatments, and other changes impact the industry.
I am incredibly fortunate to have lived and worked during a period of extraordinary change in the world of medicine. Born before World War II, I accompanied my Dad doing house calls in farmhouses around rural Herefordshire in England; Holding hands, delivering babies, observing life, the natural history of disease, and death, often too young.
Morphine and Digitalis were the most common medications. The village’s first refrigerator to store Penicillin arrived in 1947. A sibling developed pulmonary TB and spent 2 years in a drafty sanitorium before being rescued by Streptomycin. Smoking was universal and killed my Dad at the age of 58. Surgery was mainly ablative and risky. Success was measured by mortality statistics. Anesthesia was primitive and intensive care non-existent. I remember inhaling ether to have my mastoid infection lanced in my bedroom.
Fast forward to 2017
Infectious diseases are almost eliminated in developed countries. There are millions of medications for most ailments, with outstanding effects. Many operations previously classified as major have been replaced by minimally invasive safe procedures, often on an outpatient basis. Artificial joints and organ transplantation are commonplace.
Incidentally, I recently visited the excellent museum in Capetown, which is celebrating the 50th anniversary of Barnard’s first heart transplant. The toll of tobacco is waning. We are living much longer.
Progress creates new challenges
All this sounds rosy, but the incredible progress provides us with two new practical issues.
- How do we choose, from this feast of goodies, the best approach for each patient’s problem?
- And, how can we provide that care for everyone in an equitable manner?
Choosing the best approach is the bedrock of the quality agenda. It means (as I think Peter Drucker stated) “doing the right thing, and doing things right”.
Doing the right thing means pursuing and relying on evidence from relevant, high quality clinical research, and involving all stakeholders, not least the potential patients. Doing it right means ensuring that practitioners are well trained and are accountable for their outcomes.
Providing care for everyone is certainly part of the quality agenda. How can we be proud of a medical system in the U.S. that denies care to so many people? A system that is essentially based on the profit motive cannot be right. I am a supporter of single-payer health care, although how to afford and achieve it remains the biggest challenge that all countries face.
I chose to join SE Healthcare Quality Consulting because I think together we can make an impact on some of these pressing issues, by studying and showing how to provide optimal practice.