By Kevin Ritchie
Medicine has been continually evolving, but the advent of the greatest public health crisis in living memory has spurred that change exponentially.
“Many doctors still practice as I did when I started some 35 years ago; their patients sitting in front of them, their details on the doctor’s desk in manilla folders and probably the same magazines on the waiting room table too, but Covid-19 has brought tele-medicine, tele-health or virtual health care, however you want to describe it, to the forefront,” says Discovery Health’s Chief Medical Officer Dr Maurice Goodman.
“When you look at the country, there is a huge shortage of medical skills at the same time we are facing, notwithstanding Covid-19, a situation where non-communicable diseases like diabetes, hypertension, cancer and others have become much bigger drivers of morbidity and mortality than communicable diseases like HIV/Aids and Tuberculosis.”
The practice of medicine has become far more complex because of this.
“Take, God forbid, a cancer of the head and neck. You’ll need a multi-disciplinary team, including a radiologist, an oncologist, an ENT surgeon, a speech therapist and many others to optimally treat the patient.
“Physically it’s very difficult to assemble such a team in one town, never mind one room. Virtual health-care however allows exactly that, with all of the health-care professionals connecting seamlessly to discuss the patient, facilitating the delivery of this kind of multidisciplinary care – irrespective of where they themselves are.”
It’s a ground-breaking concept that is critical in a country like South Africa, where there are too few doctors and even fewer specialists and the majority of those are concentrated in the cities with little care being available in the remote rural areas.
“Significant change management is required to support the GP or family doctor’s move to a digitised and virtual practice – and to find the right way to properly and sustainably manage this transition – which is why Discovery is encouraging these colleagues to attend Henley Business School Africa’s inaugural short course titled 'Future proof your health care practice', which starts on March 10”.
Pivoting to a virtual practice is not simply a case of bolting on a digital solution to the current working set-up, but re-engineering the practice in some cases, says Goodman.
Some practices are still run by a person sitting at the front desk with a big diary, a pencil and a rubber, working out appointments and trying to squeeze in urgent patients. Virtual health care does away with all this, making consultations much more convenient for both the patient and the doctor, allowing both of them greater flexibility, reducing or eliminating travelling time and more.
In the Covid era, this is also much safer for both. While there is obviously still the need for a physical consult in many cases, increasingly doctors can make a diagnosis over the phone, tablet or laptop; issue scripts electronically to pharmacies which then dispatch them to the patient via an app, where the patient can track the delivery of their prescribed medicine – much the same way they would track their fast food orders or grocery deliveries.
Discovery has also gone a step further helping to introduce the TytoCare device into the country, helping caregivers or parents to transmit clinical grade information to doctors on the other end of the virtual consultation.
This information could be diagnostic quality images of their children’s, or their own, throats, ears, nose or skin lesions. It could be temperature reading or the sound of the breath or the heart or any other relevant clinical indicator.
In many cases, says Midrand GP and Asaipa chief executive Dr Unben Pillay who will be one of the guest lecturers on the course, the quality of the images is better than what many doctors currently physically get from their own otoscopes or torches.
“It’s daunting transitioning from pen and paper to digital,” says Goodman, which is why the Henley Africa course is so important.
“Most of the modules are a mix of medical and practical, but the final module is the most exciting. It culminates in a business template that creates a 90-day plan customised for each doctor because the way it will play out for every doctor making the transition will be different. Generically it will be the same but the experience on the ground will differ between individuals.
“During this phase, Henley will be sitting with the adopters literally doing a hand-holding process, trouble shooting as and when problems emerge.”
The hope is, says Goodman, that the doctors who successfully migrate their practices will in turn assist their colleagues to make this transition.
“When actual doctors stand up and tell their peers how it has worked from their own point of view, the process becomes so much more credible and so much more powerful.”
Goodman is an evangelist for telehealth.
“Firstly, from the country’s perspective, it can greatly facilitate the migration to Universal Health Care, which is an issue close to my heart and a strategic priority for South Africa. From a Covid-19 point of view it protects both the patient and the doctor because there are few more risky environments than a busy doctor’s waiting room. We all know that.
“The same can be said for hospitals where people contract superbugs despite the incredible efforts of health care personnel to keep everything clean and hygienic.
“Another great benefit of telehealth is the freeing up of beds in hospitals for those who truly need them, allowing others to be treated in a step-down environment or at home by nurses who can then virtually interact with a doctor or other members if the multi-disciplinary team to ensure the patient requires the holistic care they need in a low-risk and comfortable environment.”
The course has been designed by Professor Martin Hall, a former deputy vice chancellor of UCT, and is being led by Dr Peter Cruse, a former chief pathologist at Groote Schuur and UCT professor, using expert lecturers from the US, UK and South Africa, including Foster-Pedley.
“The pandemic has provided us with our greatest challenges,” says Henley Business School Africa dean and director Jon Foster-Pedley.
“But paradoxically also our greatest opportunities. Helping doctors across the country future proof their practices, while increasing access to world class health care across the country, is the kind of challenge we live for.
“We were the first business school to pivot to virtual learning when the lockdown was imposed almost a year ago. We didn’t lose a single class of MBA or executive education, on the contrary we radically expanded what we offer, while letting other business schools share the technology we had developed and the learnings we received.
“As we pioneer this initiative in the health sector, the first of any business school on the continent, we intend to do the same again, because if we all work together, we build a better future for everyone – and that’s what the biggest lesson of Covid-19 has been for me; the need for us all to build back better.”