I am an urgent care physician and have practiced primary care medicine in the past. I am one of the first contacts for patients with STI’s. In this post I’d like to discuss the recent CDC report on rising STI rates in the US.
We are talking about chlamydia, syphilis, and gonorrhea – these are devastating diseases once we account for complications, how easily they spread, and antibacterial resistance.
Gonorrhea has been among the fastest growing STI’s with high rates of antibiotics resistance. According to that CDC report, the resistance rates have increased from 1% to 4%.
We know that the prevalence of the disease is far higher in the community than what’s reported which makes it an even bigger problem. And these rates have been rising during prosperous economic times – imagine what would happen if the economy took a downturn.
Sexually Transmitted Diseases
STI’s don’t care about country borders. They don’t discriminate against sexes and races. Many of them have no symptoms at all.
STI’s also take place in individuals who either are too embarrassed to seek care, are ignorant of their symptoms, or don’t have easy access to clinics.
The problem isn’t just diagnosing the disease but also convincing patients to get a shot in the ass or take pills for 10 days – not to mention overcoming the distrust patients have for clinicians in the first place.
Then there is the stigma of having an STI. A patient will be reluctant to see a doctor because they fear the diagnosis. Many will prefer to live in denial, waiting for their junk to fall off.
Parents
Parents are among the worst perpetrators of sexual oppression and unintentionally help STI’s prevail. Sorry to put this on parents but I’ve practiced medicine long enough to witness it.
The youth are too embarrassed to come to the doctor and often afraid of bringing something like this up to their parents. And since our medical system makes it hard for kids to get access without parental consent, we are doing damn near everything possible to delay care.
I think it’s incredibly hard being a parent but parents can push for STI management to disentangle from mainstream medicine. That’s what this post will be mostly about.
Delay of Care
Delaying care of a URI doesn’t mean much. In fact, one of the best ways to spread an upper respiratory tract infection is by seeking care. Cough up your lung in a waiting room and you’re sure to infect a few innocent bystanders. Though, as an urgent care doctor, I thank you for the free affiliate marketing you provide.
When we delay the diagnosis and treatment of an STI even by a day, we allow it to spread. One person with chlamydia will have sex with 3 people. Those will have sex with 3 more. You get the picture.
Because this isn’t a linear matter, as in the case of CAD, and more like compounding interest rates of your investment portfolio, even a little more time means an exponentially larger spread.
STI Clinics
One way of managing these obstacles for patients is to create STI clinics.
This doesn’t solve all the problems. I’ve had young patients, specifically female, who have gone to places like planned parenthood and have gotten talked down to and felt judged by their clinicians – usually NP’s.
I have considered opening an STI clinic but I am not the right candidate. I am a male physician and I don’t care an iota for the trouble involved in examining female patients.
The potential profit margin, too, is low for me. Not low overall, but too low for me to risk seeing patients in person.
I think that a medical professional could quite successfully build an STI practice which could beat the pants off of the Planned Parenthood model and still turn a $200k+ profit a year.
And though this will capture quite a few STI patients in the US, it won’t capture all. And that’s why I suggest to separate STI care from medical care. This isn’t a wholly new idea. The majority of health startups are attempting to take parts of healthcare out of medicine in order to allow clinicians more time to manage patients.
Home Test Kits
Several companies offer home test kids for patients. These aren’t the rapid tests which give you results on the spot. Instead, you collect the specimen and send it off to a lab and receive results within 3-5 days.
An 8-panel STD test costs $269.
It’s not that these are bad option but you can see that the prices aren’t cheap. If you consider the reason that the average person gets a delay in diagnosis, it’s often due to being young, poor, or not having access to a mailbox.
Rapid Test Kits
There are companies which also offer rapid test kits. These have slightly lower accuracies but are FDA approved.
For $99 you can get a 7-panel test kit.
The prices still aren’t cheap and, once again, a person has to go online, pay for them, and have an address to get them shipped to.
All these are hurdles which someone with a potential sexually transmitted infection will likely not attempt to overcome.
Intelligent Automation
If medicine is failing the rising rates of STI’s then it might be time to inject some technology into the matter. I could see it being done without technology but that would require a lot more resources.
- place diagnosis and treatment in the hands of the public
- gather patient information through an AI platform
- administer medications discreetly
- allow anonymous partner notification
- minimize contact with a medical professional
- get conditional exception from the government
Do you guys remember back in the day when we couldn’t share HIV results with patients? Now there are rapid home HIV test kits which are handed out by numerous organizations. So, medicine does evolve – slowly.
The list above is the recipe for inhibiting further STI rise in the US. It won’t even require the buy-in from women-hating and gay-hating politicians and clinicians.
1. The Public
If you build a protocol and place a computer in charge of data collection then you can have the public be in charge of STI diagnosis and management.
Sure, on the back-end, far from view, there will be a medical professional who will supervise and orchestrate the care. But on the surface it will be the barista, the local barber, the gym attendant, the masseuse, or school teacher who will handle everything else.
2. AI Platform
I don’t want to look into the bitter, tired eyes of a doctor as I’m telling them about my burning dick or my discharging vagina. But I wouldn’t mind doing so on a computer screen.
In fact, I wouldn’t mind if a web app popped up which allowed me to enter all my symptoms anonymously. Then it could assign me a code and I could take that code anywhere I wanted to in order to get testing done and treatment rendered.
3. Medications
I know, we’re doctors and we’re super smart and only we should be trusted with giving out medications because otherwise terrible things could happen.
Sadly our pharmacists in the US have been hiding behind computer screens, complaining about how hard their job is. At least, the public still trusts pharmacist more than doctors.
And it doesn’t have to be a pharmacist. We trust a mechanic with our lives who replace our breaks. If we trust an electrician to wire up our house so that we don’t burn to death overnight, then we can trust certain individuals in the public to take on the task of responsibly dispensing medications.
I mean seriously, giving someone a Rocephin injection – give me a fucking break. Anyone can do that. I will trust a carpenter or chef much more than a medical assistant.
4. Partner Notification
Dear Joe, you got the clap [followed by sound of applause]. Not funny? Fine, substitute whatever the hell else you want.
But notifying potential partners doesn’t have to be a face-to-face thing. The same AI app which collected your symptoms can ask you the contact information of your partners and send them anonymous messages telling them that they should get checked.
5. No Health Professionals
We have to get rid of medical professionals when it comes to managing STI’s. I am not referring to HIV which requires complicated, long-term management. Anyway, there are brilliant and caring ID docs who handle that. Wherever they fall short, their RN’s and NP’s and PA’s pick up the slack.
Thinking you have an STI is bad enough. Burning when you pee is terrible. The last thing you want is to have to go in to see a doctor.
Take the clinicians out of the picture. That includes MD’s, DO’s, NP’s, and PA’s. I would include anyone in healthcare except for pharmacists.
The reason I think pharmacists are great for this job is because they are ubiquitous and are the the engineer-equivalents in healthcare. They are more than capable of diagnosing, treating, and managing diseases.
I’m sure many pharmacists don’t want the extra clinical burden because they are worried about an even higher workload with the same pay. But this is the US – capitalism. Eventually, more pharmacy technicians will take over the mundane jobs of pharmacists and we will remunerate the pharmacist for th extra value they bring to patients.
6. Conditional Exception
We create conditional exceptions all the time. It’s when the government looks the other way when something is done for the greater good of society.
During the Ebola scare, everyone and anyone who was available was trained to screen for Ebola. Suddenly the screening work which only was trusted to clinicians and RN’s was entrusted to the average Joe.
Also, do you remember how quickly the first Ebola vaccine came out? What was it, 2.5 months after the first Ebola report came out? Suddenly the FDA was able to bypass all its red tape.
Opportunities for Medical Professionals
If you’re an NP then it’s possible for you to open your own clinic in many states in the US. Consider starting an STI clinic. You can always add technology into it later and get grants for attempting to do so.
If you’re a clinician who is tech inclined then consider recruiting investors and startup engineers who will help you build a platform where you screen patients online. I would expect VC’s to be interested in this.
Consider partnering with pharmacies to deliver the care for STI’s. You can do the screening online and manage the disease via the pharmacist.
If you’re a pharmacist then petition your licensing board to allow a pharmacist to take over the entire process of STI management. If your particular state is reluctant, consider asking more progressive state pharmacy boards.