"I'm Sure It's Nothing" and Other Medical Emergencies

You had surgery. They sent you home. The anaesthetic wore off. Now it's just you, some painkillers, and the TV remote trying to make it through the week. A lonely vigil while you wait for your hernia to settle; or your new hip, or that nose to feel normal.

Depending on where you live in the world, and what combination of private and public healthcare you have you could be visited by a nurse. But probably not. You are unlikely to see your general practitioner. You almost certainly will not see your surgeon again. If you start to feel acute pain, chances are you will pop a few more pills, change the channel, grin and bear it. There's really no need to make a fuss. Unless there is.

Modern medicine likes to get you in and out fast. Hospital beds are the activity drivers for costs at any patient care facility. The most highly trained staff (specialists) need to see as many people as possible every day to wring value out of the system. It's a production line. A wonderful, super-hygienic production line of human repair where the mechanics are some of the best and brightest our society can find and train. In one end go the sick, out the other comes the fixed on their way to a full recovery. Everything is modelled on this throughput. Do it once right, do it right and all the funding models stack up. Do it wrong, and things get nasty. The costs of repeating or fixing a procedure are enormous. A patient getting readmitted costs not only the additional margin above and beyond the original operation, but also the opportunity cost of taking up a bed that should be used for someone new to get patient care.

Back to you. If that fever is an early sign of infection; or that the mesh has slipped, or the septum deviated, you are likely to go through a fair bit of pain before you admit something is really wrong. You are only human. You know that lovely surgeon has a lot more to worry about than your post-operative complaints. Only If things go really wrong will you get to see your surgeon again. You will be readmitted to the emergency room and triaged back to the front of the line. If only there had been a way for you to comfortably provide feedback sooner - before it all got so messy and expensive.

Given the high-cost impacts of readmittance, health care providers are eager to mitigate hospital returns as much as possible. So are insurance companies. Fix once, pay once is a better plan than cycles of payment for the same ailment. As sophisticated as many of our healthcare systems are, and certainly there some fabulous hospitals worldwide, the system is still not set up for the patient to accurately give feedback. At the end of the day, even in a national health system, you are the customer. Shouldn't your feedback be taken into account?

Imagine a factory that builds something important for your well-being – say a car. Imagine a factory that has a monopoly on building cars in your area but never gets direct feedback from you or the other people that drive similar cars that the factory has built. Imagine the only way you could suggest how to improve the car or express any sort of view of how it performed was if you took time out to visit a mechanic that was related to that factory, tell them and hope that the message got passed on. Your car brakes go soft, so you have the factory replace them, then, almost immediately, the brakes go soft again and, before you get to visit the mechanic, they fail. And they fail completely. You swerve across a road, broke through a farm fence and hurt the farmer inside. Passers-by call for an ambulance. That’s how most healthcare systems work today.

Rarely if ever do patients get to give real-time feedback to the clinicians and clinical care teams that have operated on them. Reporting of post-op problems only happens when a patient goes back to the general practitioner, and if the problem is big enough when that patient gets readmitted in a critical condition.

Researchers, administrators and even the wonderful clinicians in our system have known for a long time that patient-reported outcomes are critical for good post-care outcomes. The data is well documented. If patients have a way to give real-time reports back to the clinical teams that operated on them they get readmitted less; get more accurate timely follow on treatment, and may even live longer.

There are many reports that show how important patient led reporting is. A recent study saw one group of cancer patients provided with the usual really good care, and the other group the usual really good care plus a way to give direct reporting on how they were feeling (This is called Patient-Reported Outcomes or PROs). The study showed that 7% fewer patients in the PRO group needed to visit the ER again. The same study showed that survival was five months longer among patients in the self-reporting side of the study. Five months! A better life for longer just by being able to report back how you were feeling.

So how do you get patients to provide worthwhile, quality information back to the clinicians and not clog up the phone lines with long-winded stories about unrelated minor health issues. Paper-based surveys have been shown to be effective, calling patients and taking them through a questionnaire on the phone has been shown to work. Ideally, though you manage a single service that can phone, fax and, most interestingly, query patients directly from their own mobile device.

An optimal system would wrap some smart data insight and management tools around such a patient reporting system and add machine learning to mine the data across patients. Imagine a virtual after-care assistant that automatically, and pleasantly, contacts patients and asks them how they are going. A system that spots the outliers in the data as soon as they crop up, and nudges the system to intervene early. Catch and fix before they get bad enough to take themselves back to ER.

Of course, applying AI to healthcare is nothing new. IBM has been busy curating unstructured data in the form of medical journals into Watson for almost a decade in the hopes that their Cognitive Computing platform will aid clinicians in diagnosis. The results? Mixed.

Meanwhile, telemedicine is coming ahead in leaps and bounds. Virtual doctors replacing the Flying Doctor in Australia, and remote surgeons guiding clinical care half a world away. This is all very helpful from a medicine delivery perspective, but the voice of the patient is still strangely absent. Until now.

Practical while also being sate of the art, and certainly with some serious machine learning credentials is the physician-led Zedoc platform*. Zedoc is getting serious attention in hospitals in Singapore, Australia and New Zealand. Zedoc allows patients to provide direct feedback via the international PRO measurement standards to the clinicians who cared for them – just like in the study above.

As governments and insurance companies take a firmer stand on mandating PROs we will see systems like Zedoc as a standard part of our healthcare – commenting back via our handsets (and maybe even AI driven clinician avatars) on post care symptoms. We will tell our phones how we feel, we will be encouraged to whinge and detail our symptoms in full; that will be good. We will feel heard, we may even live longer, and the voice of the patient will be as important as the voice of the customer.

*Disclaimer: Allectus has invested in Zedoc's parent company The Clinician.

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