Future of surgery
Despite all the technical advances over many years, the surgeon remains an indispensable part of the operating room. Robots will enable us to operate more accurately while 3D computer data will enable navigation while operating. For example, glasses which can project 3D fluorescence imaging with combined PET imaging during an operation. These are great advances but our core business remains the same .
In the Netherlands, macro-economic developments will significantly impact the surgeons practice outside the operating room. There is increasing demand for medical treatment closer to the patient and for greater patient involvement in determining their medical care.
This diagram illustrates a change in the Dutch health landscape and particularly how the government and the health insurers envision the future of medical expenditure. The inverted pyramid shows the current situation with the greatest expenditure going to secondary care ( hospital care) and less to the primary care ( general practitioners ). Further the patient has little involvement in determining their care. The future will see the inversion of this pyramid.
Government and the health insurers will actively manage this transition by making agreements with hospitals to do less. Hospitals will be rewarded if they decrease expenditure as a whole and will discard certain treatments that could more efficiently be provided by primary care organisations. For example, small surgical excisions undertaken in the GP practices.
Hospitals are likely to contract and/or amalgate. New and renovated hospitals are likely to be smaller and more focussed on complexe care.
Self management will also be an increase focus of government and health insurers . That trend is already evident in the significant investment in projects such as eHealth and disease prevention programmes.
In this regard Machteld Hubert has played an important role with her new definition of (positive) health;
'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity'.
She has developed an instrument which scores this positive health ( see illustration) and has established an institute to champion this approach : www.ipositivehealth.com
Outside the operation room the digital revolution will evolve rapidly. Electronic devises will be able to collect patients data, electronic patients files will be in possession of the patients, video consulting, networks and social media will dictate the future of surgery.
I believe that the surgeon in the future will be working partly outside and partly inside the hospital.
Outside the hospital
1. Outpatients consulting/ second opinions ( facetime/ video )
2. Patients networks
3. small surgical operations under local anesthesia in the 'first' line
Inside the hospital
1. The 'real' operations and the expensive diagnostics
In my opinion the developments are going so fast, that an active attitude and anticipation of the surgeons are necessary. To make our work great again.