THE BLOG

Where There Is No Doctor

12/04/2013 10:57 am ET | Updated Feb 03, 2014

If you're a parent, you've probably been through this too many times to count.

Your child comes to you in the middle of the night, complaining of pain in her ear. Her temperature is rising and she can't get to sleep. Other than giving your daughter children's Tylenol there isn't much that you can do.

You know that in the morning, you'll call the pediatrician's office to tell them that your daughter has another ear infection. All you really need is the prescription for the antibiotics, but the doctor will insist that he examine your daughter's ear himself. If you can get an appointment the next day (and that's a big "if"), you'll wait in the reception area for an hour with a cranky child, the doctor will look at here ear for about 10 seconds and then declare, "Yep, she's got an ear infection." He'll write a prescription and hopefully 12-24 hours later, you'll have the antibiotics you knew you needed last night.

What if there was a way to spare that half day you had to take off work, not to mention the sleepless night you had to put your daughter through?

Ear infections, urinary tract infections and bronchitis fall under the category of "precision medicine," according to Clayton Christensen, the author of The Innovator's Prescription. These are the kind of conditions that are the most common drivers of physician visits and they are also clear to diagnosis and treat.

With the shortage of primary care doctors in America soon to hit us, we as patients and consumers will need to rely less on doctors to diagnosis some of these common conditions.

When it comes to primary care, we're about to see long waits for visits and even shorter visits to boot. There are a number of factors that are making this so: the Baby Boomers aging, the Affordable Care Act will mandate that all Americans have some kind of health care coverage, and a disproportionate percentage of medical students are opting for lucrative specialties instead of primary care. (The Affordable Care Act does give a 10 percent boost to Medicare payments for primary care and incentives to boost the number of primary care docs, though.)

But access to primary care is so important to preventing conditions before they become chronic and costly. If we're going to lower health care costs overall, we need more primary care, not less.

The answer is for some of the responsibility of diagnosing and treating these "precision medicine" conditions to fall to non-doctors.

In some cases that could be a nurse practitioner at a retail clinic like MinuteClinic. In other cases, it could be the parent who uses a home health device to diagnose an ear infection, send the images to a doctor, and then pick up the prescription at a pharmacy. A device just like that called CellScope could be on the market next year.

Here's a run-down of other promising technologies that could empower patients to take charge of their health:

  • Alivecor is one of the first of these devices to be approved by the FDA. It's an "iPhone ECG" that sends data directly to your cardiologist.
  • ScanduScout, called a "real-life 'Star Trek' tricorder," uses sensors, which after being placed on your forehead will take your vital signs, including your heart rate, respiratory rate, and blood pressure in 10 seconds.
  • My personal favorite is Opternative. (Especially if you read my last post.) They promise to develop the world's first online eye exam for $20.

Doctors and the American Medical Association will fight these changes, no less. Not only will these technologies disrupt their business model, but they also hate the idea of relying on patient-gathered data. This is an understandable objection given our American tradition of litigation. But if the alternative is weeks and weeks of wait for a primary care visit, no care could be more harmful. Not to mention the fact that doctors make misdiagnoses all the time. Medical error is the third leading cause of death in America if you believe this study.

The irony is that many of these new technologies will be available in the developing world before they're available here because there are fewer regulations and entrenched interests to contend with. Places like India acknowledge that they have a problem with health care access, which is something that some of our politicians are in denial about.

The FDA is going to have catch up with technology, doctors are going to have to practice letting go, the tort system is going to have to be reformed, and patients are going to step up if we're going to solve this health care crisis.