Episode 4: Dr. Eric Topol says ‘step one is providing healthcare to all citizens’

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Fixing Healthcare co-hosts Dr. Robert Pearl and Jeremy Corr thought they new a lot about their latest guest, Dr. Eric Topol. They’d both read his bestselling books and closely followed his groundbreaking work at Scripps Research. And then Dr. Topol opened up about his plan for fixing American healthcare.

Each month, a new guest appears on the show to compete for the highly coveted (and totally fictitious) role of “Leader of American Healthcare.” The guest is given 10 minutes to present his plan for radically improving the U.S. medical system and Dr. Topol didn’t waste a second of his time.

Here are some of his most memorable quotes:

The United States is the only country that does not provide healthcare to all of its citizens. That needs to be fixed. We can’t address the reduction in these critical metrics unless we provide healthcare equitably among all U.S. citizens. That’s step No. 1.

At least a third of the $3.6 trillion a year in the U.S. that is spent (on healthcare) is wasteful, unnecessary, and harmful. That has to stop.

I view the professional societies as trade guilds. Basically, their role … is largely to preserve the reimbursement of their constituents. They’re not interested in fixing these problems. They don’t have any role—and that goes not just for the AMA but across the board—in dealing with the waste and unnecessary procedures and testing and treatments. That’s a problem. We can’t rely on professional societies to lead the way because they’ve shown us for decades that they are not part of the solution.

One of the most absurd aspects of medical care in this country (is) that our electronic health records are proprietary systems (owned) by the likes of Epic and Cerner and Allscripts. They have no real interest in the patient. The problem with electronic health records is that no one in this country has all their data—from being in the womb through the present time—and they all should. They should see their data, they should own their data, and it’s just the opposite of the way we’re set up here. That has to change. My solution there is that we forget the whole idea of the current model. We need to reboot. Every individual should have their medical data.

How can we reduce hospital costs, because that’s $1.2-trillion-a-year and rising quickly? The way we can do that is to get rid of hospital rooms. We’re not talking about getting rid of the emergency room or the operating room or the intensive care unit, but the rest of the hospital should be gutted and (patients) should be at home to avoid the 1 in 4 chance of serious harm or error that takes place in the hospital … and the ridiculous cost of a hospital stay in the United States, which is approaching on average $5,000 a day. We have exquisite remote monitoring capabilities now and we should be using that. Just like decades ago when we saw the big shift from inpatient to outpatient, we need to have the shift … from inpatient to home.

Seven minutes for an appointment in a clinic is grossly inadequate, and that’s for a return visit. Twelve minutes, on average, for a new patient consult is ridiculous. The gift of time can be achieved by using analytics. That is: deep learning, artificial intelligence, taking data that’s from not just the electronic record, (but also) from sensors, from genomics, from all different sources and being able to process that data and put an investment in making life better. It can make medicine more efficient, improve workflow, and give the gift of time to both clinicians and patients.

I’m very much a proponent of telemedicine. I think it’s a welcome addition to the ways that we can connect clinicians and patient.

Unfortunately, today we still have most American physicians unwilling to communicate with their patients through email or other electronic means, which is remarkable. If you ask them why don’t they do that, it’s just because we don’t get reimbursed. Everything’s ‘I don’t get reimbursed,’ so we have to fix the model of reimbursement if we’re going to make some headway. We’ve got some real roadblocks there.

We know that the doctor who suffers from burnout has twice (the) rate of medical errors. We know there are more than 12 million serious medical errors in the United States every year and that number is not going down, but rather increasing as the rate of burnout increases. We need to make life better for clinicians.

We have a lot of genomics today that we’re not using, particularly polygenic risk scores for the most common conditions that include heart disease, breast and prostate cancer, type 2 diabetes. These are probabilistic, but if you have hundreds of variants from a low cost, high throughput genotyping that costs today less than $50, you could go into prevention mode. All these things are actionable, but we’re not using them. Part of this problem is we have a lack of comfort among clinicians using genomics.

We hope you enjoyed listening to this episode of “Fixing Healthcare.” Don’t forget, you can also read this episode, as well …

READ: Full transcript of our discussion with Dr. Topol

Next month, Dr. Donald Berwick joins the podcast to share his plan to transform healthcare. Dr. Berwick is the former president and CEO of the Institute for Healthcare Improvement (IHI) and led the organization’s 100,000 Lives Campaign, a nationwide initiative to significantly reduce morbidity and mortality in American healthcare. He’s the former administrator for CMS and has served on the faculty for Harvard Medical School and Harvard School of Public Health. We’re looking forward to having him on the show.

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Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple Podcasts or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.