A few weeks ago I went to see a doctor for a small thing. This is how the whole thing went down:
- First I asked around in my circles about a good doctor; I got recommendations, some of them conflicting;
- Then I called a few of them up — after 30 mins listening to various versions of the same music, I managed to get a booking — 3 weeks from then, at a time that was inconvenient but manageable. (The back and forth about time and address over the phone was cute — a flashback of sorts, to the olden, kinder days when the telephone ruled supreme);
- On the day of the booking, I crossed town and showed up a few minutes early; I was handed several sheets of paper and a pen, to fill up my details.
- After another 30 mins wait, I was called in.
- The doctor looked at what I wrote down, frowned, asked two quick questions, mumbled something and gave me a referral to a lab — I was out of their office in 10 mins, tops;
- On the way out, I agreed on a day for the follow up visit, and paid a small fortune for the whole thing;
At this point my afternoon was a write-off.
A few days later, armed with the lab results, I returned at the pre-agreed time. The usual 30mins waiting around, followed by the Dr. looking quickly over the results, a super short Q&A and I was out, armed with a prescription.
On the way out I paid a small fortune, a bit less than first time though, this being a follow up visit.
By the time I was done at the Pharmacy, my afternoon was a write-off.
Healthcare: The UX sucks
As a product experience this feels pretty sub-optimal.
Everything that happened there could have been done remotely in a matter of minutes. Would have been cheaper, too. And probably more reliable.
In fact the whole thing felt almost medieval. I cannot think of any other industry that has changed so little at the level of the user interface.
In this recent article in the NY Review, the author hits the nail on the head:
Our system of commercial medicine, dominated by private insurance, regional groups of private hospitals, and other powerful interests, looks more and more like a numbers racket. We would like to think we have health care that incidentally involves some wealth transfer; what we actually have is wealth transfer that incidentally involves some health care.
While medicine as a science has evolved tremendously, the front-end between patient and doctor has not fundamentally changed for a very long time.
And it gets worse.
If you peel off the interaction layer, what you find at the back-end is plain and simply terrifying.
A money-guzzling black box the workings of which no-one fully understands. Middle-men. Rent-seekers. Special interests. Corruption. Obscure processes and money changing hands. Shady companies and institutions exploiting the fact that most reasonable people have abandoned even the hope of understanding the workings of the system. It’s mind-boggling.
What is certain is that there are only two groups of participants in modern health-care:
- Those who get enriched; and
- Those who get screwed.
To the surprise of no-one, both doctors and patients mostly belong to the latter group.
A Time for Change
It is pretty obvious that the healthcare experience — particularly at the level of primary health care — can be improved a lot, quite easily. The complete interaction I described above could have been done just as easily over my phone, from the comfort of my living room. I would have saved a lot of time, hassle and money. The doctor could have seen twice or three times more patients in the same time, at a fraction of the cost for them. .
This whole thing is past due for disruption. Has been for a while and there are brilliant people out there working on alternatives. In fact, right now, quietly, every big tech company is working on healthcare products and accelerating their work with smartphone-based health, wearables, a.i. and big data. And they are smart to do that.
Now, Covid19 is putting wind in the sails of these disruptors and perhaps provides a welcome opportunity to finally go around the gatekeepers and bring healthcare into the modern era, where it belongs.
I am personally super excited about this. Here are some trends to watch:
1. Telemedicine will go mainstream;
Just like remote working (or virtual learning), telemedicine has been around for a while, but for various reasons never went mainstream (at least in the west).
And just like remote working, Covid19 is accelerating adoption of telemedicine. All of a sudden it became obvious that quality care can indeed be provided remotely. In fact, it may be that better quality of care can be provided remotely than in person — in particular for those who happen to live far away from world-class medical infrastructure.
Telemedicne can be a great equalizer in terms of access to quality services. You could live in a remote rural area and have access to the same primary health doctors as your privileged relatives that live around the corner from the Mayo clinic.
2. Direct to Consumer (DTC) Health
Health is a high touch, heavily intermediated affair. Basically, healthcare doesn’t scale. Which is why most of the world’s population simply doesn’t have access to basic health services.
For many decades now, public health programs have tried to bring traditional health services to where people are and have mostly failed. I have myself spent many years of my career part of such efforts.
Yet, perhaps we don’t need to try and scale traditional services. Perhaps we should simply change how we think of (and deliver) health services. With at least a smartphone in most households, consistent internet penetration and cheap, ubiquitous sensors everywhere, we can finally roll out direct to consumer health.
3. More rapid iteration in health.
As in other sectors, Direct to Consumer models will unlock rapid feedback loops that can help health professionals act quickly and rapidly on reakl time data. This will quickly improve the quality of services provided — and their acceptability by patients. Which will accelerate innovation not only in the way we deliver these services, but also in the sort of interventions that ARE actually possible — and impactful — with the tools that we have.
This is a very exciting trend and I can’t wait to see the impact it will have in democratizing access to health.
4. Increase role for AI and data-based diagnostic and treatment
A lot in health involves complex pattern recognition. Modern a.i. Is much better than people at pattern recognition. Visual AI applied in radiography and even diagnostic of things like cervical cancer are now trivial part of modern healthcare. Acoustic AI is now emerging as a promising trend (Disclosure: I have co-founded a company in this space ).
A.i. scales infinitely and cheaply. If incorporated into comprehensive DTC models, a.i. can commoditize diagnostics and other routine high-touch medical services, making them available to anyone with an internet connection at the cost of a few pennies.
5. Healthcare as a service
Direct to Consumer Health and evolution of a.i. and consumer tech will unlock another exciting trend: healthcare as a service.
Basically, people will subscribe to things like quarterly checkups, blood work and over time will receive truly personalized, automated, highly relevant health services on the go.
By applying SAAS principles at scale — and taking out all the intermediary from the system — such services can become ridiculously affordable. As they should have been all along.
These are exciting times. As an investor and entrepreneur, I have my eyes wide open to this space.
Edit: With this post I am not in any way trying to discard the importance of context and a human touch in quality care. However, there is a lot that can be delivered directly to patients that would not threaten the human touch, but instead amplify its impact.