Immunotherapy, virtual visits, and team-based care are poised to change how medicine is delivered.
JAY L. HESS, MD, PhD, MHSA, the 10th dean of Indiana University School of Medicine, the largest medical school in the country. He sat down to discuss research, medical education and where patient care is headed.
What do you see as the greatest opportunity in medicine?
It is now possible to have all the genetic information for many diseases—in particular, cancer—and we are beginning to understand how to use that information. Taken together with some remarkable advances in immunotherapy, I think we’re going to start curing some cancers that have really plagued mankind. That’s a big, exciting opportunity.
How do you envision patients interacting with physicians and the health care system in the future, and what will the patient experience be like?
The experience of being a patient is going to change dramatically. Think of how stores used to be open from 9 to 5, or how we had to wait in line inside banks during certain hours. That’s no longer the case. I think sometime soon we’re going to have around-the-clock health care. So any time, day or night, seven days a week, you can call someone and they will evaluate you and decide whether you need to come in. And even if you do need to come in, there will be 24-hour centers that are more convenient than emergency rooms.
There are also going to be more virtual visits. You don’t necessarily have to go to your doctor’s office to get evaluated. We already have technology that allows you to hook up your smartphone and measure your blood pressure or get an EKG. It’s not unreasonable to think the day will come when you can prick your own finger and put a drop of blood on some little analyzer if you’re a patient with diabetes or you need a drug level. Physically not having to go to the doctor’s office will be a big step.
I also think, even though I’m dean of a medical school, that more and more care will be provided by people other than physicians. Physicians will have oversight, but there just won’t be enough physicians, so a combination of technology and other kinds of care providers will be really important.
How is medical education today different than when you were in school, and how do you envision it evolving?
When I was in medical school, you learned from the patients you saw, and it was kind of by chance. You might have a patient with Type 2 diabetes who was in ketoacidosis, and you managed them as you got their blood sugar down. But someone else wouldn’t have that experience. Another student might treat a patient with a different medical condition that you wouldn’t see. A big change in medical school is that we are systematically ensuring that all students see the most important common diseases and know how to manage them. We do that in part with simulated patients.
Another big change is that there were very few people who actually would watch me as a student, let’s say, do a physical and give me specific feedback. You were on your own back then. Now we have the OSCEs—Objective Structured Clinical Examinations—where we’re really looking at the totality of a student’s interaction with a patient, from the first introduction until the end. Do they introduce themselves? Do they make eye contact? Do they ask the patient if she has any questions? These sessions are observed and students are given specific feedback on the content and the approach. They’re assessed on the different dimensions of professionalism.
Similarly, with our simulation center, students can get experience with very urgent situations. When I was a medical student and somebody had respiratory arrest or cardiac arrest, you found yourself in the middle of the situation and you had to try to figure it out. Now—just like airline pilots—you have the opportunity to practice and understand what your role is, what you are supposed to do, and how you work together in teams.
Health care is such a team-based profession. When I was a student and I started on the wards of Johns Hopkins Hospital, I didn’t know what a charge nurse was, and I didn’t really know who the other health care professionals were or how to work with them. Now we have interprofessional education. We work with students from the other health sciences schools to understand what they do, how to communicate with them, and how to work as teams. It’s much more intentional.
How can we make Hoosiers healthier, and what role can IU School of Medicine play?
We have to take a multifaceted approach. Some of what we do involves working with the state Department of Health and legislators to develop policies and enact legislation that are good for health. I think of things like providing more information about food in terms of calories in restaurants, and taking evidence-based steps that we know will reduce smoking, like the cigarette tax. We are working with the governor right now on the whole issue of opioid addiction.
What keeps you up at night?
I actually sleep very well, but there are certainly issues that I spend a lot of time thinking about.
We are a very large, complex School of Medicine with nine campuses. One of my big concerns is how do we ensure that every single student who comes to the School of Medicine has the same opportunities to receive an excellent education, have research opportunities, and take full advantage of our clinical opportunities? How do I hardwire that, so that once you’re accepted to the School of Medicine, the whole state is your campus and you can find and seamlessly take advantage of all these great opportunities?
Another big concern I have is ensuring the public understands the importance of what we do. When we make recommendations or develop new therapies or do research, it’s because we’re trying to improve lives through better health. When there are moves to try to reduce the NIH budget or other research or clinical programs, it says to me we need to do a better job communicating the value of what we do and what’s at stake.