Julian Robinson | Making medical progress work for Jamaicans

The pace of change in medicine is extraordinary. Research continues to expand what we know, new treatments are changing the options available to patients, and technology is transforming how physicians diagnose, monitor and manage disease.

For a profession built on knowledge, this creates an obligation to remain curious and willing to change. But there is another question that is particularly important for Jamaica: how do we turn advances in medical knowledge into meaningful improvements in the lives of our people? That is not always as straightforward as it sounds.

A new treatment may be clinically effective, but its impact is limited if it is unaffordable or unavailable. A new diagnostic technology may be transformative, but only if our institutions have the equipment, trained personnel and systems necessary to use it. Research may give us a better understanding of disease, but its greatest value comes when that knowledge changes what happens to a patient.

As we consider the future of medicine, we must look beyond what is possible and ask what is practical, sustainable and accessible in the Jamaican context. Our circumstances differ from those of larger, wealthier health systems that often set the benchmarks for medical innovation. We have finite resources, a changing population and significant demands on our healthcare institutions. We also have to contend with the realities that determine whether people can actually access care.

FROM KNOWLEDGE TO IMPACT

Jamaica cannot simply measure progress by how closely we replicate what is being done elsewhere. We must develop the capacity to assess new evidence carefully, determine what is relevant to our population, and make strategic decisions about where our resources will have the greatest impact. That requires collaboration across the healthcare system. Government has an important role in policy and investment. Universities and research institutions generate knowledge. The private sector can contribute to innovation and investment. Professional associations help to establish standards and advance medical practice.

Physicians, particularly consultant physicians, bring another perspective that is difficult to replace: direct experience of what happens when policy and practice meet the patient. Your role extends beyond treating individual patients. You train and mentor the doctors who will carry the profession forward. You influence standards of practice and contribute to research and professional development. Because you work at the point where medical knowledge is translated into decisions about real people, you can often identify where the system is succeeding and where it needs to improve.

The wider question is: what does healthcare mean for Jamaica’s development? We sometimes speak about healthcare primarily as an expenditure, something for which the country must find the resources. Healthcare does require significant investment. But we should also speak about it as an investment in our productive capacity.

The health of our population affects whether people can work, learn, care for their families and participate fully in building a productive society. Effective management of chronic diseases can prevent complications that impose costs on families and the healthcare system. Keeping people healthier for longer allows them to remain productive and engaged in their communities.

The quality of our healthcare has consequences far beyond the hospital or doctor’s office. It affects the quality of the country we can build. That is also why developing the medical profession matters. Senior physicians are responsible not only for keeping pace with medical developments, but also for preparing the next generation to practise in an increasingly different environment.

HUMAN SIDE OF MEDICINE

Young doctors coming into the profession will have access to an extraordinary amount of information and increasingly sophisticated technology. Artificial intelligence will undoubtedly change aspects of how medicine is practised. The question is not whether technology will change the physician’s role. It will.

The more important question is what we expect the physician to continue providing when technology can increasingly provide information, analysis and recommendations.

Clinical judgement will still matter. So will ethics, experience and the ability to understand the circumstances of an individual patient. A machine can process information, but medicine requires someone to determine what that information means in the context of a particular person and a particular set of circumstances.

This is why mentorship remains so important. The knowledge young physicians need is not contained entirely in textbooks or databases. Some of it comes from experience, difficult cases, and observing how senior colleagues think. Perhaps most importantly, they learn it by understanding what it means to treat patients with dignity and respect.

Recognising excellence within the profession is important. The achievements of senior physicians represent years of work, but they also represent the standards they have helped to establish for those who will follow.

As the medical profession considers emerging evidence and the ways practice must evolve, we must ensure that progress in medicine does not remain an abstract idea or something that happens elsewhere. It must ultimately be reflected in the quality of care available to the Jamaican patient.

If we can combine the best of emerging knowledge with the realities of our society, continue to develop our institutions and our people, and preserve the judgement and humanity at the centre of the profession, then the evolution of medicine can become something much bigger than technological or scientific progress. It can become progress that people actually experience in their lives. That is the work worth celebrating, and it is the responsibility that lies before all of us.

Julian Robinson is the opposition spokesperson on finance and planning. This article is an abridged and edited version of his speech delivered at the Association of Consultant Physicians of Jamaica’s 24th Annual Symposium. Send feedback to columns@gleanerjm.com