The beginning of the new year marks the beginning of some significant endings. Most importantly, with the approved vaccines for COVID-19, we can finally see the end of the pandemic on the horizon. Most notably, however, we can see the end of the pre-COVID ways of thinking about and practicing medicine.
COVID-19 has laid the foundation for transforming the shape of medicine. Through personal and societal impacts, the pandemic has left many feeling dehumanized and isolated. This isolation, however, has given us an opportunity to ponder our personal beliefs and recalibrate how we want our lives to look. This past year has brought a heightened awareness of the existing economic and health inequities and rampant racism, as well as the impending perils of climate change. These problems have long existed and continuously threatened our ever-so-fragile ecosystem. Through its devastation, the virus has emphasized the need to take better care of our planet and the life on it.
An inability to learn and improve from these events will be a huge disservice to all of the people who we have lost this past year and all of their loved ones.
Among the lessons that this pandemic has forced on us, there are four that can and will broadly shape the medicine of tomorrow.
Lesson 1: The Advent of Sensor-Aided Virtual Care
They say adversity breeds innovation, and virtual care has been a product of this sentiment. As COVID-19 kept everyone indoors, telehealth continued to allow care to be dispensed while keeping patients and providers safe. The positive impact of this on access, efficiency, and cost-effectiveness of care delivery cannot be overstated. It goes without saying that a big driver of the future of medicine will be sensor-aided virtual care powered by predictive analytics and self-care algorithms.
Like much else in life, the human body and its organs are being digitized. Sensors will help us proactively capture information and allow us to predict and prevent disease. Chronic diseases that remain the Achilles heel of the healthcare system, along with the growing emphasis on wellness and prevention, will be the central focus of this care revolution. Remote monitoring will become the nerve center for clinical practice, with command stations gathering crucial clinical and longitudinal information for high-risk patients who need close follow-up to prevent complications.
This will reconfigure the patient-provider dynamic and evolve the business of medicine. We will be able to better serve our patients through continuous and timely interactions. The rate of digitization will invalidate prevalent business models and the economics will evolve to focus on outcomes as a part of the value proposition. The business model will change from one that is transactional to one that will reward continuous care. It is the visionary organizations and hospitals leading the way out of this crisis that will set the character and cadence of this change.
The success of this revolution will be determined by both the digital speed of innovation and our ability to adapt.
At this stage, there is no clear roadmap; it is for us to construct one. As we embrace the reality of a digital transformation, we need to ensure that these technologies and this care overcomes the existing inequities in healthcare and is accessible to everyone.
Lesson 2: Addressing Social Disparities
When it comes to COVID-19, Black people are twice as likely as white people to be hospitalized, and also face a death rate that is over two times higher than that of white Americans. And despite making up around 30% of the U.S. population, Black and Brown communities have been faced with over 50% of COVID cases nationwide. With this increased morbidity and mortality in our marginalized communities, the pandemic has highlighted huge gaps and inadequacies within our healthcare system. Beginning with access, studies have shown that more than half of the uninsured population in the U.S. are people of color. Beyond access, structural discrepancies, such as living standards, education, and social inclusion, are also critical contributors to this widening divide. In addition to the immediate control of the pandemic, we need structural changes within our healthcare system to overcome the inequities that disproportionately affect our Black, Brown, and Indigenous American communities. Without equitable care, we do not have a properly functioning health system.
Lesson 3: Tackling Structural and Systemic Racism
Much has transpired over the course of the last year leading to a national reckoning of racism. Within medicine, racism exists in many contexts: from patient-provider interactions to institutional and workforce dynamics, varying degrees of racism exist within the foundations of our health system. By consequence of this, we often see an element of distrust and discomfort among Black and Brown patients, as well as among many Black and Brown providers. Much of the patient distrust is a consequence of the inherent prejudices harbored within the medical community and shocking studies like the Tuskegee syphilis experiment. Moreover, there continue to exist several treatment protocols in cardiology, nephrology, and obstetrics, among a host of other disciplines, that are based on racist assumptions.
Clearly, there is much work to be done. Despite this, narratives on social media continue to highlight how hospital executives continue to treat this as a box to merely check off. There are symbolic gestures and hollow overtures, with little concrete action towards righting the wrongs within the medical system at large. We continue to see a lack of access to care, the absence of translation services, an increased likelihood of calling security on a patient of color, the withholding of pain medications to patients of color, and incomplete medical workups for these patients.
It is not a new phenomenon for leadership to disregard people that don’t look like them, and in many institutions, leadership has evolved in a way that continues to keep people of color away from the table. Some of this may not be intentional, but just perpetuated by age-old racism that has been hardwired into the administrative structure. To change this, we have to break down the structure and rewire the house. Every day, overt racial injustices and subtle microaggressions need to be challenged and cleansed. This will not happen without adequate representation. Institutions need to make it their central focus to hire and elevate more people of color, while collectively creating a more inclusive and trustworthy culture.
Lesson 4: We Are All Connected
The spread of the virus has emphasized our global connectivity. We all breathe the same air and what happens at one end of the globe will ultimately impact the other end. We must work together, across borders and boundaries, to contain diseases and disseminate best practices for better global health. As international travel and commerce come back to the forefront, the threat of other communicable diseases will surface again. Our economies and well-being are intertwined, and they must be valued and treated holistically. Beyond government initiatives, it is the responsibility of hospitals to expand their footprint and establish connections and care with less privileged regions of the world. In doing so, we can better respond to — and even prevent — the occurrence of another global pandemic.
It’s much too easy for us to revert back to our old ways after this pandemic has passed. Many of the lessons we’ve learned can become a distant memory very quickly. As humans, we will naturally suppress and forget our personal hardships. We will once again become hardened to the recognition of life’s fragility and the rampant disparities, racism, and inequities before us. After the devastation we’ve felt throughout the year, we cannot allow ourselves to again become short-sighted and focused on personal petty preoccupations. Through the most trying of times, we have been given an opportunity to better our global society. It is our responsibility to aid and abet this transformation of medicine, ensuring patient-focused and equitable care across all communities, across all human beings.
Jag Singh, MD, DPhil, is a cardiac electrophysiologist, physician-scientist, and professor at Massachusetts General Hospital and Harvard Medical School. He is passionate about social issues, digital health, and medical innovations.