The Rise of the Non-Physician Expert and Implications for Care Management
Posted Feb 12 2013 9:46pm
The Disease Management Care Blog remembers when one of its patients with coronary artery disease suggested that he be given a course of an antibiotic to lower his future risk of a heart attack . The patient had done his homework, quoting literature that pointed to a possible infectious link to atherosclerosis. He also was aware of the theory that aspirin's benefit had less to do with blood thinning than reducing underlying inflammation.
All of which makes the DMCB wonder if the vaunted Doctor of Medicine degree may be vulnerable.
Why should physician education be immune from a perfect storm of over-priced graduate education, "alternative" web-enabled learning with on-the-job-training? The declining value of the formal credential may be less about the university degree and more about competency, turbocharged by flexible licensing and a discerning consumer.
Non-physician health care professionals are arguing that their expertise is enough to enable them to deliver babies , administer anesthesia , prescribe drugs and perform surgery . The DMCB's traditionalist colleagues argue that patient safety is at stake and that lay persons may not be able to discern all of the possible risks, benefits and alternatives. When things go occasionally wrong in the delivery suit, operating room or with a drug, they say a credentialed and experienced doc can make the difference between life and death.
The DMCB also remains impressed by the ready availability of medical information in the public domain that is enabling some laypersons to become astonishingly expert. In addition to the patient above, think about the self-taught parent of a child with a rare condition or the plucky cancer patient who guides the oncologist toward choosing the right life-saving therapy. Imagine what happens when IBM's Watson is fully commercialized and available to anyone at anytime.
The physician DMCB understands all the perspectives above, but given the decline of the BA and the law degree, it worries that the medical traditionalists may ultimately end up being on the wrong side of history.
While regulators and the markets sort all this out, this may open another business proposition for care management. As patients with chronic conditions continue to seek ways to better share in their self care, they'll also be seeking providers that best suit their needs and expectations. In other words, the population health vendors can not only help with shared decision making , but provider selection making.