Also known in its abbreviated form, disintermediation, this means ‘cutting out the middle man’.  It has become a popular phrase as electronic business has developed.  As you can imagine, electronic business and commerce has the great potential of getting rid of middlemen.  In healthcare, this means bringing the patient closer to the professional.

The essential quest of medicine is to bring a patient with a problem over here, to a doctor with the answer over there.  In other words, there is a doctor somewhere with the answer to the patient’s problem; if only we could get them together quickly and easily.  Usually this involves multiple steps, if it happens at all.

Well, that’s where electronic systems come into their own.  They offer the prospect of bringing problems and solutions together, i.e. knowledge.  This type of activity is traditionally done by third parties, e.g. a GP.   However, it’s pretty much up to chance if your particular GP knows the answer to your problem, or even knows where to get the answer.  (Samuel Johnson, 1709-1784 said, “Knowledge is of two kinds. We know a subject ourselves, or we know where we can find information upon it”).  Unfortunately, the NHS in the UK insists on maintaining the intermediary, even when s/he is patently unnecessary.  Think about this, you can’t access a specialist in the UK without going first to a generalist; what waste!

Middlemen everywhere will cry, “But we add value!”  Well, maybe; but not all the time.  Often they just add cost.  And a lot of the value they do add can be equally, if not better, done by electronic systems.  For example, an algorithm-based questionnaire can ‘shape’ a referral to the best locality.  Decision-support software is already available for GP’s, why not make it available to the patients themselves, thereby cutting out the expensive middleman?

Soon the distinction between knowing a subject ourselves and knowing where we can find information on it will become meaningless.  Look out middlemen!


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