In the early 60's, my father started in medicine making house calls.
He would carry his black bag from home to home. It had all he needed to make a diagnosis and get the patient on the road to recovery. Now, 50 years later, no one can lift this black bag. It is too heavy with options. Improvements in care have meant more options, so much to know that no single person can have all the right answers.
Overall, Americans have benefited from medical advances. We are living longer than in the 1960's. But, it has also had the perverse effect of fragmentation. Take the example of my mom, a quadriplegic.
At times her care sounds more like a text on physiology. There is someone for the lungs, the kidneys and the neurologic system. Yet, no one is responsible for her. In part, this is too much for one person, there is not speciality called "quadraplegia" and all that goes with it. In part, this is how healthcare is reimburse- money is paid for problems, rather than wellness.
However, I see hope on the horizon. Like Hermione's magical bag in the Harry Potter series, we can give our providers all that they need as they travel from house to house, or at least room to room. Collaborative technologies can deliver the community, rather than strictly the provider, to the bedside. In this world, the black bag is replaced by an iPad or other PDA. The specialist is available for advice, supporting and reassuring the patient and local provider alike. This is our future. We need to learn to scale our healthcare ecosystem, to not rely on the best available locally but rather the the best available from anywhere in sustainable ways. New economic incentives are accelerating these solutions. Time to upgrade that old black bag, time to go back to the future.
