Snowbirds and Distance Medicine

THIS ISSUE’S FEATURE ON snowbirds establishing and maintaining their cancer care for their periodic migrations hardly seems to be a corollary for the future of health care, but in many ways, it is.

In this day and age of complicated diagnostics and detailed care plans that may involve multiple specialists, the portability of medical records is essential. The story of the challenges and solutions surrounding snowbirds taking a patchwork approach to address their care is likely to change every year as our society becomes more mobile, and even global (more Americans are buying their drugs overseas and even embarking on “medical tourism”).

But there is much more than portability at stake — for one thing, the quality and cost of medical care. It is clear that an inexorably rising proportion of our incomes is going to medical care and insurance. Unsustainable costs along with poor distribution, limited access and occasionally spotty quality of medical care will force an eventual reckoning with market forces driven by consumer demand. We are already seeing some of these trends with low-cost neighborhood clinics, telemedicine, self-diagnostics and a proliferation of health information and advice websites.

Snowbirds are responsible for some of this: Many cancer centers have made efforts to routinely give their clients CDs of imaging test results and offer portals that allow them to tap into compatible electronic medical records to look up labs and appointments and to send messages back and forth. Many physicians and staff members even network with the oncologists and other specialists their patients see where they reside part-time.

Social media, electronic medical records and new standards and regulations for tissue/blood-based and imaging diagnostics are all elements of the weather vortex that will transform medicine. Like most transformational events, the timing and nature of what will happen are impossible to pinpoint, but I will take liberties in making some general predictions. For one, patients will become much more informed and educated participants — in many cases with the help of others, including hired (or virtual/robotic) professional navigators. Secondly, patients will have many more options and not be limited by geography or the professional networks of their primary physicians. Third, automated/computer-assisted diagnostics, along with portable devices that could even be attachable to smartphones and run with apps, will proliferate (many already exist), and low entry barriers into the market for these will increase competition and lower prices. Fourth, care will be less disruptive to people’s lives, with less travel to the hospital/clinic and more videoconferencing, remote sensors and probes that can replace the old-fashioned visit. Fifth, care will be more democratic, equalizing costs and disparities and enhancing overall access.

This may seem a long way off from the simple snowbird’s visit to a “retreat” oncologist, but like most trends, it didn’t originate in one sector; rather, it is arising from a convergence of movements that meet at just the right time.

DEBU TRIPATHY, M.D.

Editor-in-Chief Professor of Medicine Chair, Department of Breast Medical Oncology The University of Texas MD Anderson Cancer Center