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Disease Fundamentals and Treatment Options Part A
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From the course by Duke University
Healthcare Innovation and Entrepreneurship
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From the lesson
Finding What's Needed
What are the key elements of disease fundamentals? What are our treatment options? What is the most objective method to observe and document the disease process? Can treatment methods be understood through process improvement?
Meet the Instructors
Marilyn M. Lombardi, Ph.D.Associate Clinical Professor
School of Nursing
Bob Barnes, PhDInstructor
Biomedical Engineering
Ladies and gentlemen, hello. This is Bob Barnes.
And on behalf of Marilyn Lombardi and myself, I'd like to welcome you back to
Healthcare Innovation and Entrepreneurship.
In this series of two, we're going to be talking about Disease Fundamentals and
Treatment Options. Well, here we are.
We're still in our first, pardon me, our second week of finding what's needed.
And in this sequence, we are going to be talking about, as I said, disease
fundamentals and treatment options. Let's take a look at the beginning of
these. Disease fundamentals.
And we're going to start out with this, talking about how do physicians see and
interpret the patient. The physician many times sees the patient
through a cloud. Let's think about it.
The patient presents what conditions. Let's think about ourselves.
There are only so many different ways that we, as a patient, can present our
conditions, our ailments, to the physician.
The physician has a tendency to look at us, guess what?
As physicians, which may be a little different in terms of the way we look at
patients if we were an innovator, an entrepreneur in an ethnographic
investigation manner. Let's pursue this further.
Physicians are trained strongly in anatomy and physiology.
S,o as a consequence that's one of the first things they do is when they look at
us as a patient, they look at us in terms of our,[COUGH] the systems we have, and
our organs. And how they're working.
They then ask, how are they working contrary?
How are they operating contrary to the way in which they expect them to work,
the way in which they are supposed to work?
In other words, they first look at what's the gap between what they expect.
And what they perceive. They do this from a clinical
presentation. When two pieces of the clinical
presentation, what they see and observe from us passively.
And what they observe and see from us when they palpitate us and or take an
active investigation, too, and see how we are presenting in a clinical environment.
They then think about what are the clinical outcomes, in terms of how we may
or may not be responding. We ask then how frequently, or they may
ask how frequently does this condition occur.
because think about it, when we're doing a disease analysis, in essence, the
physician is trying to eliminate all the things that are what we're presenting
could represent, and trying to identify those things it could be.
So, this truly is a filtering process. So, the lower frequency items,[COUGH]
there's something that they're not looking for right off.
In fact, that's one of the things we have to worry about in medicine in general.
We'll talk some more about that, is how sometimes we're predisposed to diagnose
what we expect or what frequently occurs. And then, this last thing that many
physicians would be concerned about, the economic impact on themselves, on the
patient, and or society. Don't get me wrong, physicians think
about these things in societal terms, just like all the rest of us do.
And in personal terms, in terms of how wounds is being diagnosed and what
conditions may be, may, how, that may affect us as patients.
When we look at these conditions as people that are being immersed in a
specialty or observing within a healthcare environment.
When we try to do business in ethnographic perspective, that is,
observing without judging, we will see and be interested in all the things that
the sur, pardon me, the surgeon and/or the primary care physician or the
physician's assistant or the nurse may see.
We tend to look at five things. We ask five questions.
Maybe we don't ask them out loud, but we ask them mentally.
What are the complaints? What are we observing?
What are the symptoms? What has changed from being healthy to
being suspect to being healthy? Being happy with our condition to being
unhappy with our condition, from being in a situation in which things were
acceptable, to which perhaps our, our healthy status is not acceptable to us.
What are the consequences? What are the outcomes?
How could this effect us? Short-term and long-term, and how can it
effect us as an individual patient? And how can it effect us as a family?
And to some extent, how does it effect as, as society?
We then may ask as we're observing that those of you who have been observing in
the healthcare environment, be it in a hospital or primary care facility.
Or in a public environment, like inner city for example, just observing
healthcare. Just observing people that appear to be
sick or to have ailments. What frequency does this occur within our
population and what are the broader impacts in terms of economics?
If you think about these, the things that we're concerned about, as innovators and
entrepreneurs, and to those people that are observing healthcare within our
comminity, this is the questions we would normally ask.
It leads us, in many cases, to the same information, we just pronounce to go
about it a little differently. Now, from an innovator or an
entrepreneur's perspective, these are all questions we'd like to have answered.
But from the innovator and entrepreneur perspective, the first question we'd like
to know is, what is this frequency? How often does this condition present?
The second question we may have the, is what are the economics associated with
it? In other words, how bad is a problem
economically? How bad is a problem from a societal
perspective? How bad is a problem in terms of pain and
suffering? How bad is the prob, problem in terms of
opportunity loss to the individual and or the society?
Therein, we begin to see our leverage in terms of how much we can afford, either
in terms of dollars or currency, and how much we can afford in terms of effort to
invest in addressing the particular problem.
From there, we may be interested in consequences because the consequences is
really what provides the other end of the ladder for us, the other end of the see
saw if you will. There is, how much is it going to cost to
alleviate the problem versus what a value or the outcomes as a, as a consequence of
this. We also, in many cases, as entrepreneurs
and innovators, may be interested in what's changing in terms of
pathophysiology. What's changing in terms of the anatomy,
what's changing in terms of physiology. What changed in terms of how the, the
body's systems interact with each other. If we know that and we understand that,
we may be better prepared to provide interventions, or intervention assistance
to the surgeon, to the physicians, and other caregivers.
And, we also are interested in terms of, what are the complaints?
because this begins to give us an idea of detectability.
And for those of us that might be interested in diagnostics, that's an
important term. Overall, questions 4 and 5, 1 and 2, the
ones that we as innovators and entrepreneurs are most interested in.
However, if we're going to develop solutions, we need to be able to answer
all five of these. What are the complaints?
We first start with, with symptoms, which give us complaint, which in terms of we
either are complaining verbally, visually, psychologically.
But we present in some way. There's a clinical presentation on when
we go to the clinic how does a doctor see the difference between what they would
expect from a healthy individual and someone who is exhibiting the compliance
of the symptoms that we have. The effect of the disease we aim what
ails specifically. The effect of long-term consequences, now
this long-term consequences could be driven by a specific disease or they
could be driven by the treatment of an existing disease.
The effect of the treatment. And remember, there may be variations in
terms of age, gender, ethnicity, and other conditions.
And for those of us that are interested in innovation and entrepreneurship.
In many cases, we're asking questions. What are the upside opportunities for the
solution that we're proposing? And if we understand the population
that's going to be affected. And we know something about how that
population may be parsed, or may be grouped.
We may have a better way of going after that market, addressing that market and
delivering care in a sustainable manner. What has changed?
Remember, we're going through all five of these questions.
Change from normal biologic and physiologic perspective.
Causal associations. What's the rate of attack?
We're back to focusing again on age. Then, we're going to introduce something
else. Not just age, but genetics, and
lifestyle. May be things that we're interested in,
they may have something to do with being causal in some way, or it may be that
we're more susceptible depending on our genetic predispositions, our lifestyles,
and our age. What are the consequences?
As innovators and entrepreneurs, we'd like to be able to, if we're going to
have an exchange between the product, the service, and the result that we're
proposing, there has to be something of benefit to the patient and other
stakeholders. They can be expressed in terms of quality
of life. For better or for worse, quality of life
is a difficult end point to address. Quantifiable options may be more
appropriate. For example, for someone presenting with
arthritis, their difficulty maybe simply able to be being able to get out of the
chair and walk across the room. A quantifiable input maybe the number of
steps per minute that the patient can take compared to the number of steps per
minute they could take in a healthy, prior to, healthy condition prior to the
onset of arthritis. And of course, there are always outcomes
related to mortality or survivability. What is frequency?
This is epidemiology. Key background.
It's a key background for market assessment and market planning.
We'd like to know within the population, what's the incidence of the occurrence,
we like the dynamics. If we know that within a population, that
it's a hundred occurrences per hundred thousand over the lifetime of that
population. That's a different dynamic.
Then after a 10 occurrences per year, per hundred thousand, for people between the
ages of 30 and 40, we know how rapidly the onset occurs.
We may have a much better idea of how we would like to go to market and how we can
proceed to treat or support the, treat the disease.
Incidence is important, dynamics is important, population is important, and
what we're asking is consistent. What's our addressable sub-population?
And depending upon the nature of the population, the cost of our solution, the
addressable market may change dramatically.
What are the broader impacts? Economic.
What's the cost of treatment? What's the cost of the treatment
currently? We may be interested in a more efficient
treatment. It doesn't mean that the patient is going
to be any better off with a treatment we propose than the treatment they're
currently receiving, but the cost of that treatment may be lower.
Or the cost of the treatment may be more. But the efficacy, the result, may be
better. What's the cost of hospitalization?
What's the lost productivity? This in gen, genuinely represents the
opportunity for mutual, keyword, sustainable benefit, sustainable benefit
to the stakeholder, to the patient, to the provider.
And sustainable benefit for those of us, entrepreneurs, innovators, who are
attempting to discover and deliver solutions and[UNKNOWN] for existing
healthcare problems. Thank you for your attention.
This covers the first part of our discussion of disease fundamentals which
focuses on the what is, focuses on the current situation.
And when we come back and we talk about treatments and analysis, we'll talk about
how do we proceed to the change case. Thank you very much.
I look forward to seeing you again shortly.
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