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dochtúir-shláinte-1180x787De réir Chomhghuaillíocht Eorpach do Leigheas phearsantaithe (EAPM) Stiúrthóir Feidhmiúcháin Denis Horgan

It’s a fast-changing world, especially in health. And, arguably, the rise of personalised medicine – which aims to give the right treatment to the right patient at the right time - is only being outstripped in this arena by the rise of new digital tools and technologies.

The Brussels-based European Alliance for Personalised Medicine (EAPM) believes that, given the arrival of smartphones and other devices that can produce diagnostic results, plus smart pill-boxes that remind us to take our medication and wearables that monitor everything from our heartbeat to our blood pressure, medicine is on its way to becoming more democratized.

And that can only be good for the patient, EAPM and its multi-stakeholder base maintains. ‘Accountable care’ is a phrase on many health-care professionals’ lips these days, as is ‘patient-centred treatment’. And these are forward-thinking ideas in an era that has seen the virtual death of old-fashioned stand-bys such as the stethoscope as well as witnessed medical imaging and full DNA profiling both plummeting in price. Meanwhile, Big Data is here and will do nothing other than grow – the tough part now is deciding how best to regulate it – and, today, if a hospital doesn’t have all its medical records on mobile apps, it’s a virtual dinosaur. With this revolution in healthcare, the doctor-patient relationship is changing too.

And quickly. Pretty soon patients will not even have to see their doctor all the time. In fact, a recent Deloitte report predicted that one in every six doctor's appointments will be virtual by the end of this year, which will obviously save a great deal of money and time. Remote monitoring at home is also safer and carries a much smaller chance of infections. But doctors will always be there. Patients rely on them for diagnoses, treatment, and guidance. Yet there is a need for a much greater, truly democratic partnership. When patients start to be given data in real time, for example, the doctor and patient are then on an equal footing, the latter becoming empowered and an equal partner in decision making.

Today’s patients require such empowerment, and are often nothing short of demanding to have their illnesses and the treatment options explained in a transparent, understandable yet non-patronizing manner to allow them the right to co-decision. Meanwhile, they believe they have a right to own their own medical data. This includes having unreserved access to it. On top of this they require greater access to clinical trials and cross-border treatments that could improve, or even save, their lives. The bottom line is that engaged patients tend to pay more attention to their health, and this is surely a benefit to all parties. As another example that patients are becoming more demanding, studies have shown that as many as one-in-five seek second medical opinions, which often result in different diagnoses or treatments.

This often leads to third or even fourth opinions (although more than that can lead to confusion for everyone). On the other hand, getting a second opinion that confirms the first can be reassuring. Unfortunately, this growing demand for second opinions comes alongside a worry for many that their doctor will be offended by such a request. Patients need to know that this is not the case. Especially in cases of serious illness or potential major surgery or treatment most doctors will actually expect and 1 encourage a second opinion. Traditional yet unnecessary reticence on the part of the patient is one of many obstacles to their full empowerment. But there are ways to overcome them and these include better training for healthcare professionals (HCPs) in up-to-the-minute technologies and a significantly different mindset from those same clinicians that allows the patient to participate in discussion and decision-making at all levels. Also needed are regulatory changes – specifically from the European Parliament and Commission – in order to make clinical trials more accessible.

Aiseolas

Meanwhile, affordable cross-border treatments need to become a reality, which they barely are at the present time. But back to the patient-doctor dialogue: it is a fact that, during the next 20 to 30 years, patients will more- and-more often be screened and treated away from doctors’ surgeries and there will be big changes in how patients and their doctors interact in the future. Giving the patient more authority and freedom to do what they think best, for example by taking into account such things as their lifestyles, is a growing phenomenon. Increased engagement and access to information on behalf of the patient will challenge the ‘normal’ doctor-patient relationship, and other influences will come in to play, meaning that the GP may no longer run the whole show when it comes to what information the patient can access, and the treatment choices a patient may make.

Essentially, the democratization that the internet began will find a natural home in the doctor’s surgery, although the process of re-evaluating the relationship may be difficult at first. It is clear, even in the future, that the patient’s clinician will always play a major role in suggesting the best course of treatment. But HCPs will not be able to continue to do this without learning about new technologies, developing much better communication skills and giving up-to-the-minute information about choices and potential treatments resulting from patient decisions in respect of their own health. Europe now has an ageing population of 500 million potential patients across 28 Member States. It must start to act, and act immediately, to set about improving those doctor-patient relationships that need to evolve to fit modern-day needs.

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