Académie royale de Médecine de Belgique


Vidéo et Résumé de Dipak Kalra


By Dipak KALRA (University College London – President of the European Institute for Innovation through Health Data), invité.   

Our medical students need to be equipped to respond innovatively to the challenges of delivering future healthcare. The population is ageing and accumulating multiple (interacting) chronic diseases. The funding of public health systems is falling behind population demand and the rising costs of novel treatments and procedures. The resource that is surprisingly under exploited within our health system is the patient himself or herself, as an active member of the healthcare team, contributing positively to their own health care and prevention. There is a growing body of evidence that patients can play a valuable role in managing their own health care and can - in partnership with clinicians - achieve better outcomes at lower cost.

The practical challenges of enabling patients to be active players in their own healthcare are vanishing through the proliferation and sophistication of mobile technologies: portable and wearable devices, remote sensors, cloud computing and the promise of artificial intelligence. This, combined with better access to online health information and to their own medical records, creates the concept of the Digital Patient. Mobile technologies already play important roles in healthcare delivery and prevention: telemedicine was just an early example.

However, we are still training our healthcare professionals in how to operate within traditional health service models and they mostly learn by observation to propagate a patronage rather than empowerment model of patient engagement. The challenge facing the next era of education is how to train our clinicians to be ready to work more as partners with Digital Patients, and how to support patients in using that empowerment.

The next generation of clinicians need to leverage the potential of the Digital Patient. This means they will need to learn:

How to be more transparent with patients about their health status, findings, prognosis, risks, alternatives and about areas of clinician uncertainty.

How to educate patients so that they are empowered to understand care decisions and the possible risks and outcomes of treatment options.

How to educate and support patients with monitoring their long-term conditions, how to equip them to fine tune treatments as needed, how to handle deteriorations and how to use mobile technologies to help detect early signs of relapse.

About trusting patient generated data: not treating data from patients as a second-class citizen, but also how to assess its accuracy and trustworthiness.

How to undertake shared decision-making: inviting patients to weigh up the options and make their own final decision.

How to respect that patients may wish to make personal choices about health goals and trajectories, when to treat aggressively and when to adopt a gentle approach, how strongly to prevent a complication, to respect different definitions of quality of life.

How to undertake safe and supportive remote mentoring: how to help patients to care for themselves rather than to provide that care directly.

Ultimately, how to provide patients with computerized decision support so the patient and computer manage most care delivery actions, and to be the “just in time” clinician that responds to difficulties, or provides confirmation and reassurance that the computer and patient have got things right.

Most doctors do not get taught didactically about good doctor patient relationships. They learn this by observation from their seniors. This challenges all of us because it means the real paradigm shifts in medical education, such as to engage positively with digitally empowered patients, cannot be taught. It has to be demonstrated by role models.

This evolution from the passive patient to the informed patient to the empowered patient to the digital patient also raises challenges about what professionalism means, and what the future identify of the doctor should be.

If every patient could become a doctor, what then is a doctor?