The healer's art: Placing trust back in today’s health care
I have been fortunate to practice medicine during an era of great scientific progress. The pace of this transformation remains exponentially greater than at any other time in human history. Just a few decades ago, there was only a comparatively limited pharmaceutical repertoire. Imaging was distinctly primitive compared to current computer enhanced techniques. The sciences of genetics and immunology were just emerging in modern form.
Yet, as is true with all aspects of human experience, progress of one sort can have its shadow side. In an attempt to match our worthy instincts to expand access to care and still cope with increasing costs, we have been simultaneously propelled towards an inadvertent yet consequential social experiment. As we go forward, if the system that is being erected distributes care episodically and through many fragmented providers, in whom we will place our trust in matters of health?
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This was never a pervasive issue in another age. Despite significant limits in effective patient treatment up until the recent past, many people had a personal and valued relationship with their own physician. Paradoxically, when little could actually be done, the stature of the medical profession was at its zenith. Trust in one's own personal physician used to be extremely high and was an unheralded and essential linchpin in our medical experience. Throughout history, that specific bond between treating physician and sufferer was considered a crucial element in patient care and this has been the case since the shaman's chant.
However, our rapidly changing system has made no overt attempt to recognize this relationship. Yet, it surely matters and likely accounts for the unprecedented recent growth of boutique medical practices. The well to do want to assert their right to access medical practitioners in whom they place deep trust.
In an earlier era, the burden of decision-making was typically placed on the physician. Any trusting patient had the comfort of being able to accept a course of medical therapy without deep inner conflict. How quaint and ill informed that would seem to many sophisticates today. But in truth, who is better equipped to undertake the decision?
The willing transfer of decision making from patient or family to physician can only be based on a trusting bond between physician and patient. Up until the recent past, those relationships were often present and expected. Such bonds permitted a degree of latitude in the practice of medicine that young practitioners cannot even imagine in our current regulatory environment. In many respects, it served both patients and families very well.
It is different now. Patients are expected to fully participate in complex decisions about their care. Frequently then, choices are made after a cursory examination of incomplete sources based on an urgent Internet search. The results can be confusing, jargon filled, and statistically dense. Although important information can be gleaned, that same process may yield incompletely understood perceptions of risk, unrealistic expectations, or the inadvertent undermining of realistic hope. What is gained in one sense can be lost in another.
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What might we make of this dilemma? For our policy makers, there should be an overt appreciation that such a sense of trust can only be preserved through the traditional link between personal and familiar physician and patient. That trust, and the faith in healing that under girds it, has worth. And that faith, once lost, is not easily regained.
Importantly, trust is never a unilateral phenomenon. Any patient must feel assured that their physicians are not scrambling to enhance their incomes by becoming improperly inured by pharmaceutical manufacturers, medical device makers or from competing health systems. Trust is always fragile and must be earned and maintained. Perhaps this is nowhere more true than was demonstrated with our recent experience with Ebola. Our leaders and our medical bureaucracy inaccurately asserted that our health system was fully prepared to monitor and very efficiently deal with Ebola. In real time, at least with the first few cases, our system was shown to be under prepared. Episodes such as this undermine that imperative of trust.
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Any breakdown of the system of the healing arts which has existed throughout human history will have significant unpremeditated consequences. It will be costly in terms of insecurity, doubt and worry, futile or fringe treatments or effective therapies unsought. As a nation, we have embarked without adequate reflection on a vast new societal experiment lead by policy makers whose primary concern is process and political popularity. It is highly likely that for their own medical care, these same individuals will insist on the prerogative of medical circumstances and personal medical relationships in which they feel a sense of trust. They will demand that their care be delivered by those in whom they have faith. Should we not all be allowed the same? Let us insist then that our policy makers remember the place that trust, faith, and the healer's heart have on our own lives.
I offer this admonition to our policy makers, "Wherever the art of medicine is loved, there is also the love of humanity." – Hippocrates
Dr. Bill Miller has been a physician in academic and private practice for over 30 years. He is the author of The Microcosm Within: Evolution and Extinction in the Hologenome. He currently serves as a scientific advisor to OmniBiome Therapeutics, a pioneering company in discovering and developing solutions to problems in human fertility and health through management of the human microbiome. For more information, visit www.themicrocosmwithin.com or www.hologenome.com.
How healthcare can safeguard itself against cyberthreats
One of the most fundamental lessons from the COVID crisis is that health should always be a priority. In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.
The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics.
From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world.
The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years.
This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate.
Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.
To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care.
Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change.
It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device.
These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.
Despite this, there are fundamentals that any organisation should implement:
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.
In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.
Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents.
Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.
This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents.
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.
Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.
As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.
Fighting future threats
With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.
To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced.
This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.