SOUTH Africa’s clinicians have been amazing during the COVID pandemic, but they haven’t been backed by the same level of material and logistical support says Dr Peter Cruse.
Now Cruse, a former chief of pathology at Groote Schuur Hospital and former professor of anatomical pathology at the University of Cape Town, is leading South Africa’s first ever telemedicine course to address this gap.
Developed and presented by Henley Business School Africa, the unique six-week course is designed to help medical doctors especially transition to virtual medicine and digitise their practices in the process. It’s the latest innovation from the award-winning business school and the seed of what will ultimately become a bespoke healthcare school, alongside its centre of innovation and entrepreneurship and its research department, according to Henley Africa dean and director Jon Foster-Pedley.
Cruse was speaking on a panel hosted by the British Chamber of Business in Southern Africa, moderated by chamber president Leon Ayo and which included Foster-Pedley and leading British oncologist Naren Basu, who founded and runs the Birmingham Breast Group in England, a partnership of 17 leading healthcare professionals.
The pandemic, said Cruse, had provided an invaluable opportunity to improve the quality of service doctors provide to patients, while lowering costs. The key to this had been the realisation that medical practitioners are not taught the necessary business management skills while they are learning their craft at medical school. The COVID 19 crisis had also opened the door to look at the way medicine is currently practiced in the country.
“Healthcare and education are key pillars to the development of any society. This intervention allows us to address both,” he said. “We are currently looking at an, as yet unpublished, study of time and motion in traditional consultations to see what we can engineer out as we pivot to virtual medicine.”
Early results had been very encouraging, suggesting a possible 30% saving in time, increasing the actual doctor’s quality of life allowing them the space to do other things.
“Some of our practitioners on the course are now using that extra capacity to treat uninsured patients.”
Collaboration is another key aspect of virtual medicine, with the potential. Especially in cases like cancer, virtual medicine allows multi-disciplinary teams of specialists to provide seamless full spectrum care literally across the world reducing the iniquitous access to health care in the process, said Basu.
“COVID 19 hit us hard, especially in Birmingham, where we had the largest intensive care unit in all of Europe, which soon became full to capacity (with pandemic patients). We were (still) diagnosing patients with cancer, but we had nowhere to put them for three weeks. This was heart breaking and devastating.
“Now when we are trying to restart other normal clinical services, it is very difficult to prioritise between scheduled procedures and it’s creating a very divisive and toxic atmosphere over the equitable access to healthcare.”
Cruse agreed: “We are trying to engineer out repetitive, time-consuming tasks. In Cape Town, there is a massive problem with Tuberculosis, where the sputum cytology – up to 2 000 samples per day – are still studied by hand, with a high human error risk. Artificial intelligence can be taught to do this.”
Other health providers have imported remote health monitoring devices during the pandemic, which operate like a smart phone. In the UK, Basu said, the Royal Berkshire Hospital had been able to set up a virtual ward, using oxygen saturation as the key triage point. In South Africa, said panel audience member Terence Naidu AI has being introduced not to replace radiologists but to augment them.
The opportunity here was to reduce the load on staff and on resources, allowing some patients to be treated at home, out of hospital and accordingly less anxious. “The possibilities are immense, it’s a very exciting time to be in medicine,” said Cruse, “as the borders between countries and technology disappear.
“In Cape Town, radiologists are diagnosing 1500 CT scans every night for the NHA in Britain. We’re hoping that once COVID 19 is brought under control we will keep the gains.”
The momentum of change in other aspects of medicine has been as heartening; the Health Professional Services Council has quickly regulated virtual consulting, health insurance funds have made it claimable for patients while from a medico-legal perspective there have been major moves to rule what kind of virtual consultation is allowed and therefore protected by law – and which are not.
“Hybridised medicine is becoming the new normal,” Cruse said; a far cry from the way he had been trained, where “if you can’t put your finger in it, you’ll put your foot in it”.
The model in future, he said would be that patients would not go to the hospital for care unless it was an absolutely essential surgical intervention. Artificial intelligence and augmented reality would help establish which cases needed hospitalisation or not.
At the moment though, he said, virtual consultation still remained inferior to the old laying on of hands diagnostics and bedside manner of real consultation, but, as Foster-Pedley noted, the speed in the development and growth of technology would soon bridge this too.
“Every night watching TV unlocks a range of emotions, there’s more engagement, it’s more captivating than ever before,” he said. “We need to develop the skills of that. There are many technologies, blending the use of language and facial technologies to make contact far better and far more real – even if its virtual.”
The proof of the pudding perhaps was in the poll of the webinar attendees: 78% would be prepared to pivot to virtual medicine, but just under half remain concerned about the potential for misinterpreting symptoms and diagnoses with 25% still concerned about data privacy.