Health care system needs infusion of new management thinking

A new crop of medical graduates from Mount  Hope recently entered our hospitals as interns after utilising a minimum of five  years for intense study of the theory and practice of medicine. They are destined to spend another two years  as interns under the supervision of  senior medical practitioners of several disciplines before qualifying to practise medicine unsupervised.

Do all these years of study qualify them to practise medicine with confidence during their internship or have they simply cracked the tip of the iceberg during their structured learning programmes? An informal survey of the graduates painted a picture  of  relative chaos and disinterest among many teachers especially the senior consultants. High absenteeism, use of the fear method of teaching and hopeless scheduling of classes and ward exposure characterised the process. All these factors as well as the death of the best teacher did not inspire confidence. When the new doctors complete their internship and consider specialisation, they will need to appreciate medicine of the future as projected by Cetron and Davies. When medical students reach their senior year, half of what they learn in their first year about the cutting edge of technology is basic, obsolete, or revised, since medical knowledge doubles every eight years. Medical research is responsible for a great deal of the astonishing developments in medicine. The Human Genome Project promises possible cures for haemophilia, cystic fibrosis, familial hypercholesterolemia, cancers, and AIDS.

As many as 300 treatments for hereditary disorders are expected to enter clinical testing by 2005 and eventually, about 4000 hereditary disorders could be prevented or cured through genetic intervention. If early tests prove successful, by 2010 or earlier, tumors caused by cancer could be treated routinely and successfully with injections in the family doctor’s office. By 2005, artificial blood will begin to stretch the supply of natural blood which has been in short supply here and elsewhere in the world. The fear of AIDS-tainted blood has also led those in need of blood to be circumspect in accepting donor blood. The population of TT aged 60 and over is now about 10 per- cent. It is an age at which memory loss in expected to increase. The good news is that memory enhancing drugs should reach clinical use by 2010. Surgery, which most people fear, is expected to undergo advances too, in that new computer-based diagnostic tools are providing unprecedented images of soft and hard tissues inside the body, eliminating much exploratory surgery. Patient trauma will also be reduced through bloodless surgery using advanced lasers. An added advantage will be reduction of hospital stays, thereby lowering the patients’ medical costs.

Laparoscopic and endoscopic surgery are already addressed to specific areas of the body thereby reducing the possibility of side effects to other areas of the body. The side effects of drugs have always been a cause for concern. However ‘magic bullet’ drug delivery will enable enormous doses of medication to be directed exactly where they are needed. This will be beneficial in respect of cancers and other conditions requiring the use of powerful drugs. Developments in transplants will be numerous by 2005. They will include brain-cell and nerve tissue transplants to assist victims of various kinds of neurological disorders inclusive of retardation and head trauma. Muscles from other parts of the body will be used in heart transplants.  Animal organs will be in common use. Laboratories will be used to grow bone, muscle and blood cells for transplants.

Cloning and related technologies to grow stem cells can be expected to be available for use in transplanted tissues for intractable diseases such as diabetes and Parkinson’s disease within the next five to ten years. These are radical new treatments and the debate on the morality of their use is still strong. Some countries like Trinidad and Tobago may not permit their use. Bionic limbs will no longer be largely the subject matter of movies. In the next ten years bionic limbs, hearts and other organs are anticipated. Drugs will be used to prevent disease, not only to treat symptoms and body monitors will warn of impending trouble.  In terms of nutrition, nutritional supplements and foods with drugs either added or genetically engineered into them will be in common use. Later in time, by 2025, the first nanotechnology-based medical therapies should reach clinical use. Microscopic machines will monitor our internal processes, remove cholesterol plaque from artery walls, and destroy cancer cells before they have an opportunity to form tumours. There are several inferences based on these developments. 

Man has always pined for immortality and medical developments will continue to increase the human lifespan perhaps to as long as 200 years. Humans will enjoy good health for longer periods of time. Concurrently, there will be dramatic increases in health costs which  will  include artificial organs, new pharmaceuticals, and computerised monitors. The span of the normal working life will require re-examination. The number of medical specialties will increase in high-tech areas while shortages in current skills such as nurses will continue. Our newly graduated doctors will have to be involved in continuous research to keep their medical practice current with emergent medical developments and will have to become more business oriented by observing trends and employing new technology. The views expressed in this column are not necessarily those of Guardian Life.
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