The Preventers

The title of this blog “The Preventers” may sound like a movie title, but it refers to our health care system. A system that is neither about health nor about care. It’s about treating the sick. Doctors are fighting for those who are sick, preventers are fighting for our health. We need both. We have only the first.

Our current system

The Netherlands, the country where I live, is a small country. It had some great thinkers like Erasmus. Today the Erasmus Medical Center in Rotterdam carries his name. One of the things he said was “Prevention is better than cure”. Still you don’t immediately go to this hospital for prevention. You don’t even go directly when you're sick. Basically as long as you have a lot of complaints, you don’t even go to a general practitioner.

You may already be ill and you’re not living too healthy, but this is neither monitored nor checked on a regular basis. You may only have regular appointments to check your teeth.

When actually going to a doctor, most of them ‘just talk’ with you. At the appointment:

You have exactly 10 minutes to discuss exactly one thing.

Doctors have no time to really investigate your condition. In practice there is also no scientific attitude among doctors to do so. Within the system they function primarily as the gatekeeper to the rest of the health care system. Nothing more, nothing less.

The result of a doctor’s appointment can be:

  1. Nothing to worry about
  2. There maybe something, but let’s wait (take an aspirin)
  3. Here are some medicines
  4. Go to a specialist (which may take a while).

So with the first two options it may actually pass. You need to decide it by yourself to come back if the problem hasn’t disappeared. You need to be persistent that you need some help.

When you get the medicines it is being assumed that they work. There is no mail after a few weeks to fill in an online form if the doctor’s prescription worked or not. There is no feedback what the experience with the doctor or treatment was. How should we know if this was the right thing?

When coming back and the doctor doesn’t know it anymore. Only then you are being sent to a specialist. We arrive at the hospital system. There we often go from one specialist to another. We are caught up in the churn.

Walking with pain

Probably everyone has some negative experience with this part of the health care system. Here is a short story about my wife who has a foot problem. She is an enthusiastic walker. She used to walk multi-day hikes of 25 km per day. At one point she suffered from one of her feet. She could walk less and less far. Currently, walking to the nearest supermarket is already difficult.

Long before she reached that point she went to a physiotherapist, but that didn’t work out. So after a few months she went to the family doctor who sent her to a podiatrist. After not getting anywhere she was finally sent to an orthopedist.

At the hospital they performed an echo and gave her an injection. This didn’t work. After one-half year the orthopedist decide she needed surgery. For this she had to wait another half year. After the surgery and a half year recovery it still didn’t help. Then she got a second opinion. She was sent to a special physiotherapist, she got orthotics and so on. After three years she can still not walk normally and this restricts her life. Well it’s only walking, not so important for humans…

What happens every time is that

  • She needs to tell her whole story again.
  • She needs to wait for weeks or sometimes even months before the next appointment (Appointments can also never be combined).
  • A new scan has to be performed.
  • They don’t even look at her foot or do some basic research
  • A new opinion is given and a new diagnosis is established

So instead of Erasmus’ preventing, they target at curing, but this often is already a step too far as well. It’s basically just administration.

The Preventers

When you love your pet you take good care of them. You give them the right food, take them out for a walk and keep track of their well-being. Somehow we are not so good at this for ourselves. Though there is more consciousness within society to take more care of your own health, this is not part of the system. It’s your own responsibility.

Normally you take good care of yourself, with small things your doctor helps you and with bigger things specialists in hospitals will treat you. For the things there is no cure yet, scientists are searching for one. But as we saw this isn’t aligned. This system is broken.

What if the health care system takes care of us like we care of our pets? But not in caring way, but in a scientific way? For this we need a whole new class of health care professionals. I call them “Preventers”. Their main concern is not taking action on our health, but managing the causes and effects.

The preventers manifesto

I work in IT. When things don’t work we say that these are incidents. But there are special types of incidents. Either major incidents or repeatable incidents. For those incidents we try to perform a Root-Cause Analysis and prevent it from happening again.

In health this is separated between science which does fundamental research and health care which is fixing incidents. There is however not a lot of effort in research of incidents, finding root-causes and taking preventive measure.

There should go at least as much money to this field as to doctors and researchers. The role of Preventers is

  • Proactive is better than reactive
  • Research instead of talking
  • Holistic approach instead of a specialist approach
  • A data & systematic approach instead experience & intuitive approach
  • Coaching instead of therapist

The means that a preventer doesn’t work on its own, but in a health care center. The preventers in health care centers would cost billions, but at the same time would save trillions.

HEALTH CARE centers

A health care center is a center where your total health is number one. Not you have to adjust to the hospital, but the center is adjusted to your needs. Preventers work in a health care center.

Instead of saying “Take care of your health”, they say “We take care of your health”. Instead of wait until you get ill, you go there for regular check ups. The dermatologist takes for examples pictures of your body to guide changes. Blood tests and other examples are recorded. You're shopping list is uploaded from online grocery stories to the dietician. The regular visits give a complete picture of your health.

The specialist's team creates a plan for you which you discuss with the preventer. He translates this to language you understand and a plan that suits you.

Part of the team is also data scientist. With the help of data analysis and artificial intelligence he seeks for patterns and report back to the team. All is presented on a health dashboard which is also available as an app and can be connected to a smartwatch.

The visit to this health center should be set up like a customer journey of retail or as entertainment company do. Not a journey to buy product or to have a good experience, but a journey of a healthier life. And at the end a healthier system.

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