Disruption in healthcare is happening (whether we like it or not)

Healthcare, and particularly medicine, are slow-moving beasts. This doesn’t mean that innovation isn’t happening. In fact, it’s happening at an alarming speed and doctors are grappling with a quickly expanding knowledge base.

But the highly regulated, traditional industry is vulnerable to external disruption, and we’re seeing more and more examples:

  • DIY tests like skin cancer apps and pap smears
  • Online script services
  • Skin checks at the pharmacy
  • Vaccination services outside medical practices
  • Medical tourism

The flip side of convenience

Disruption is not necessarily the same as innovation. Disruptive services or products are simpler and more convenient to use, but their quality is often poorer.

In healthcare, the risk of disruption is that it affects health outcomes. It may lead to fragmentation and loss of opportunistic screening. I’ll give two examples:

Example 1:  More providers does not equal better care

A busy family doesn’t have the time to visit the doctor and decides to use convenient online health services. As a result they hardly ever visit their family doctor, and if they do, their doctor does not have the complete picture as more health providers are involved in the care.

Example 2: Convenience does not equal safety

Women doing their own pap smears at home may take incorrect samples. Although avoiding the ‘stirrups’ in the doctor’s office is a big plus, the risk of avoiding an expert examination is that things get missed.

The way forward

Disruption in healthcare is happening, whether we like it or not. “Successful entrepreneurs naturally look at opportunities in terms of the jobs they can do for customers,” say the authors of this article. Although it is unlikely that the doctor can be replaced by technology, certain aspects of the healthcare process can.

I believe there are 3 ways the healthcare industry should respond to external disruption:

  1. Continue to listen to health consumers
  2. Develop our own disruption processes
  3. Communicate the strengths and qualities of our services

Marcus Tan, GP and CEO of HealthEngine said in Australian Doctor magazine: “GPs are ideally suited to lead this cultural shift. GPs are highly skilled in managing risk and uncertainty, and are well equipped to make the leaps required to innovate.”

Indeed, if we don’t do it ourselves, others will.

Not what the doctor said

Not what the doctor said
Image: Pixabay.com

In 1976 two researchers, James Pennebaker and Deborah Sanders, published and interesting study. They placed two kinds of signs in university toilets, one reading: “Do not write on these walls under any circumstances,” and the other: “Please don’t write on these walls.” Result: the amount of graffiti on the walls with the first, more authoritative sign was significantly more.

This phenomenon is called reactance: when something or someone threatens to restrict our freedom, our intuitive response is to undo this – even if our response may have negative consequences.

Reactance can occur on a massive scale as, for example, in the case of Japanese whaling. The consumption of whale meat in Japan is decreasing – it is considered traditional food and younger generations are not interested in it. Yet, Japanese people respond furiously to the actions of the Sea Shepherd activists against their whaling fleet. Travel writer Sam Vincent, who wrote a book about this topic, concludes: “Japan isn’t pro-whaling. It’s anti-anti-whaling.”

AMA response to the ‘skin spot check’

This week a new pharmacy initiative was in the news: ‘Skin spot checks’. For $35 people can have a single skin lesion of their choice examined at certain pharmacies. The response from the Australian Medical Association was as expected. Dermatologist and president of the NSW branch of the AMA said: “It is irresponsible and inappropriate for pharmacies to offer in-store skin checks.”

Although the AMA has a point, the response can be: “If the AMA doesn’t agree, it should be approved.” Reactance in action! This may be followed by: “The AMA is probably protecting their members’ interests, so let’s give these entrepreneurial chemists a fair-go!”

If the AMA had said: “Look, doctors are busy and fed up with all these people worried about their freckles, so please go away and visit the pharmacy,” the response would probably be the opposite. I’m not arguing that they should have said this, but the point is that most doctors care about their patients’ wellbeing and this is unfortunately not always taken into account in the media and comments.

The following scenario happens often in my practice: a patient asks my opinion about a pigmented but benign skin lesion, and is not aware of the (more common) non-pigmented malignant or pre-malignant lesion elsewhere on the skin. These spots will likely be missed at the ‘skin spot check’ in the chemist store.