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'A lot we don't know': Duke med school professor discusses the future of health care

Automated, data-driven healthcare at your fingertips may seem like something out of science fiction. But according to Professor of Medicine L. Ebony Boulware, such a future may not be far off.

In an event sponsored by Duke Student Government, Boulware discussed the problems in health care today and speculated about the solutions to come. The event was moderated by first-year Jake Satisky, DSG senator for academic affairs who is also a staff reporter for The Chronicle.

“Increasingly, we’re understanding that we don’t know a lot about what makes people healthy,” Boulware said. “There’s also a lot we don’t know about ways to improve health care.”

She explained that the first steps should be to identify the causes and engineer the treatments. But just as important, she noted, is figuring out how to deliver those treatments to the public.

“What actually happens is that there are cures for diseases, but they can take 20 or 30 years to get into the generalized practice—even though they’ve been proven and demonstrated,” Boulware said.

She pointed to the quality of doctor-patient interactions as an example of problems facing treatment delivery.

“When you go to the doctor, you’re feeling vulnerable. It's really important to have a trusting relationship,” Boulware said. 

Boulware noted that it can be harder to develop those relationships when patients are seeing different doctors simultaneously. She called this phenomenon the “fragmentation of care,” where a patient visits multiple doctors to treat a single serious or chronic disease. 

A person suffering from cancer may need to see six or seven doctors specializing in fields ranging from surgery and oncology to radiation and physical therapy, she explained. As the number of providers increases, so does the burden of handling appointments and juggling treatments.

“It can become a full-time job, just managing your health care,” Boulware said.

In the future, she said she expects to see a much more simplified approach to receiving care. She predicted that advanced scanning will replace more invasive ways of diagnosing illnesses, and that doctors will rely more on data to treat them. She also foresaw a lot more smartphone use in health care and even compared the future of medicine and technology to Star Trek.

Although Boulware studied at the Duke School of Medicine and has been practicing for more than 20 years, her undergraduate record was different from many other pre-health students. Instead of choosing a traditional, science-focused major such as biology or biomedical engineering, she graduated from Vassar College with an English degree. 

And despite not beginning research until her residency, she now serves as vice dean for translational sciences and associate vice chancellor for translational research.

“I’m not as directed with my career,” Boulware said. “I do things very intuitively, and I try to see what feels right.”

Boulware also had advice to the prospective pre-health students in the room.

“What’s unique about medicine is that there are lots of different ways to be involved,” she said. “There are so many different career paths that are all so rewarding.”

First-year Rohin Maganti, one of the pre-health students in attendance, said he appreciated how Boulware stressed the importance of human interaction in medicine.

“A lot of people lose sight that being a doctor isn’t just about being a scientist,” Maganti said. “Half of being a doctor is the human part.”