Paradigms are useful tools in our modern lives. They help us to make sense of the world around us much more easily. Often, paradigms represent the tried and true — the things that worked well in the past. But more often than not, they are based on assumptions — until more knowledge becomes available.
There are business paradigms (sell a gadget for more than it cost you to make) or scientific paradigms (germs vs. miasma (“bad air”)). There are also plenty of paradigms in healthcare around diagnosis (e.g., lab tests and imaging) and treatment (one size fits all medications for anyone with that diagnosis).
One healthcare paradigm we’ll be taking a closer look at today is the paradigm around care delivery.
A brief history of Care Delivery
For thousands of years humans lived in close proximity to each other and when sick care was needed, the sick were brought a short distance to the local shaman, medicine man, or doctor.
But since transportation was often difficult, especially for the ill, many times the medical experts would travel to the patients, rather than the other way around.
My introduction to healthcare started at the Mayo Clinic and there are plenty of old photos of Dr. W. W. Mayo riding a buggy to the countryside to call on his patients in their homes: the good old house calls.
Even in Germany in the 1970s, my pediatrician would stop by our home at the end of his day to make sure that I was doing alright as I fell ill with a common childhood disease.
With the modernization and “taylorization” of healthcare, but also with the notion that healthcare should be available to all and not just those who could afford it, house calls became more and more a rarity. Especially in the US patients were increasingly expected to seek care at clinics and could no longer expect house calls by their physician.
For many patients, this turned a 10 minute doctor visit into at least a 90 minute ordeal of travel time, finding parking, checking in and spending time in the waiting room as many doctors are inevitably behind schedule, given the nature of their unpredictable job.
On the other hand, we are also no longer “wasting” the physician’s valuable time on traveling from patient to patient, so productivity in a given day could be much higher.
A Virtual First Mindset
But just like the old paradigm of making housecalls was gradually replaced with a “you have to come to me to be seen” paradigm, we are now seeing, thanks to the advancements in technology that gave us highly effective telehealth, a strong shift towards “virtual first”.