I will be delivering a lecture to the 42nd annual Congress of the Brazilian Society of Clinical Pathology (Sociedade Brasileira de Patologia Clínica; SBPC) on July 3, 2008, in Sao Paulo, Brazil. The lecture is entitled "Integrated Diagnostics Emerges as a Key Element in Healthcare." The lecture will address the development of integrated diagnostic centers (IDCs) which I believe will play an important role in the future of healthcare delivery. Below is a summary of this presentation that I was asked to write for the SBPC web site.
The general field of diagnostics, with molecular diagnostics and medical imaging at its core, is undergoing an explosion of knowledge providing the potential to diagnose disease in its pre-clinical pre-symptomatic stage before any physical manifestations are present. Such a new approach to healthcare will be very disruptive for clinicians who have been trained to suspect the presence of disease on the basis of a patient history and a physical exam. This new perspective on disease diagnosis sets the stage for the emergence of “integrated diagnostic centers” (IDCs) staffed by pathologists, lab medicine specialists, and radiologists. A patient would be referred to an IDC by a primary care physician, at which time the physicians in the diagnostic center would assume total responsibility for diagnosing the patient’s disease, assessing the prognosis of the disease, and making some therapeutic recommendations. This IDC concept is well known in Brazil where it has already been executed on a large-scale basis.
In order for this IDC concept to gain wider acceptance in the future, a number of changes need to be adopted within the specialties of pathology, laboratory medicine, and radiology. First of all, the distinctions between morphologic observations of diseased tissue and clinical lab analyses need to be blended to provide integrated conclusions about the overall pathophysiology of a disease (also see: Integration of Anatomic and Clinical Pathology). Following this, the specialties of lab medicine and pathology need to merge to form the new and integrated specialty of diagnostic medicine. Finally, a means need to be discovered to enable the reallocation of funds from the current “therapeutic silos” to “diagnostic silos.” This reallocation of healthcare dollars can be achieved by an increased focus on measuring the efficacy of current drug treatment using diagnostic methods. Given that a substantial percentage of drug therapy, particularly in the field oncology, has been shown to have little effect, the executives of health insurance companies and governmental health programs will gladly reallocate funds to diagnostics if the result is a net savings of the cost of drugs and the avoidance of unnecessary side effects by those patients receiving the unnecessary drugs.
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