The Doctor of the Future

By: Chuck SalterFri May 1, 2009 at 2:00 PM

Photograph by Jamie Chung | Prop Styling by Bryan Byrn

Cost, access, quality -- the prognosis for American health care may look grim, but innovation is the cure. The medicine of tomorrow is being born today.

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Photograph by Tanit Sakakini

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<< in two places at once >>

The call came after hours. A 36-year-old woman had arrived at the ER in Big Rapids, Michigan, with an apparent stroke. Omar Qahwash, a neurosurgeon at St. Joseph Mercy Oakland in Pontiac, outside Detroit, rushed to have a look. In the quiet of his bedroom, he flipped open his laptop and transported himself 197 miles away.

Although Mecosta County Medical Center, an 82-bed facility in Big Rapids (population: 10,849), doesn't have a stroke specialist, it has the next best thing: the RP-7, a 5-foot-tall "remote presence" robot made by InTouch Health of Santa Barbara, California. Using a stubby joystick, Qahwash, 34, zoomed the two-way camera to review the patient's chart and CT scan. Then, parking the robot at the woman's bedside, he asked several questions, carefully studying her responses. To the patient, he was a face on the machine's 15-inch monitor.

She hadn't had a stroke, Qahwash concluded. The immediate and expert assessment avoided a needless helicopter transfer to Detroit, which would have cost several thousand dollars. If it had been a stroke, Qahwash was on hand to direct treatment.

The uneven distribution of specialists is a significant problem for the U.S. health-care system. While some large cities arguably have too many specialists, small cities and rural areas generally have too few. This deficit is especially acute in cases where rapid, expert diagnosis and treatment are the most critical. Some of the most powerful medical advances are those that address this growing manpower crisis. One cost-effective way to extend expertise is leading-edge telemedicine.

Consider stroke, the third leading cause of death in the United States and the No. 1 cause of long-term disability. Only 23% of county hospitals offer neurological services. The shortage is expected to worsen during the next 20 years as aging baby boomers live longer than previous generations. So St. Joseph Mercy, part of Trinity Health, a $6.3 billion nonprofit with 44 hospitals and a few hundred outpatient facilities, has established the Michigan Stroke Network, the largest such network in the country. St. Joseph spends $2 million a year to lease 33 robots that stand at the ready in 31 hospitals across the state.

Time is of the essence with strokes. Most are caused by clots that reduce blood flow to the brain. A clot-busting drug approved by the FDA in 1996 -- tissue plasminogen activator (tPA), also known as "brain Drano" -- can work wonders, but only with certain strokes and, in most cases, only within three hours of onset. (In other cases, tPA can make things worse.) The remote robot increases the chances of treating a patient effectively. Nationally, about 5% of stroke victims get tPA; in 2007, 80% of eligible patients in the stroke network did. On average, it takes just seven minutes for a network hospital to get a neurologist or neurosurgeon on-site via robot. As the specialist assesses the patient, other members of the team prepare for helicopter transport, just in case.

The RP-7, which some hospitals humanize with a lab coat, ID badge, and name, looks odd -- even comical -- with the bottom-heavy build of a vacuum cleaner and a flat-screen monitor for a head. (It comes with sounds effects, too, including Arnold Schwarzenegger saying, "I'll be back.") But patients don't seem to mind the machine. "They're relieved that they have a specialist at their bedside," says Connie Parliament, supervisor of the stroke network. "They're used to driving two hours to see someone."

The robot "isn't a panacea," says Jack Weiner, St. Joseph president and CEO, "but it is the kind of technology that significantly reduces health-care costs." With a robot, leased for about $7,000 a month, a community hospital can offer the expertise of a neurologist it couldn't otherwise afford ($500,000 a year and up, says Weiner). That means more stroke victims walk out of the hospital, avoiding bills of $250,000 or more for months of rehab. "We think the insurance companies benefit," says Weiner, "but they are not willing to support the program yet." He wants more departments to use the robots. At St. Joseph, for example, ICU specialists make robot rounds from home before going to bed, which can prevent a late-night call. St. Alphonsus Regional Medical Center, a Trinity hospital in Boise, Idaho, uses eight units to provide neonatal, cardiology, mental health, and other services to rural facilities. And there, the revenue covers leasing costs.

Like the Myca Platform, the robots are just one example of an advanced technology that seems impersonal but actually enables doctors to be more hands-on; in a Twitter and Facebook world, screen-to-screen face time can build relationships with patients. And like SimulConsult and the robotic college's remote learning, they encourage professional connections that dramatically enhance care. Together, innovations like these are beginning to free U.S. medicine from the strictures that have given us the world's costliest health care, but not the best health care.

Think what happens when you put these things together. You can see your doctor immediately without wasting time in a waiting room. A robust database helps your physician make more accurate diagnoses. Advances in robotics cut your recovery time after surgery -- and could even lead to operations assisted by remote experts. This is the vision of the medical system of tomorrow. And it's emerging today.

"You get into medicine because you want to take care of people," says a 39-year-old general practitioner in a traditional practice in Philadelphia. "But then you discover it's not a fulfilling profession anymore." Which is why he recently decided to leave the "hamster wheel" of rushing between patients all day without a break. He's following Parkinson's lead and opening a Hello Health practice with the Myca Platform. Just what the health-care system ordered: one more doctor of the future.

Read more about Hello Health's Facebook-like Platform
Or Dr. Jay Parkinson at SXSW