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Michael R. Czinkota

On a recent holiday, I had six teeth extracted. The insights I gathered during this process seemed relevant to current policy and election travails. My dentist’s office was closed, but he kindly came in to see me. Of course, his staff did not, since it was a holiday, but that did not worry me since I wanted my doctor’s skills, not those of his staff. After a lengthy procedure, my dentist gave me a pain prescription. Kind reader, please keep in mind – our local jurisdictions consist of the District of Columbia,  the Commonwealth of Virginia, and the State of Maryland. Each state has different pharmaceutical rules and laws, and political leadership. 

My dentist resides in Washington, D.C.; I live in Virginia but have to drive through Maryland to get home. My daughter kindly offered to pick me up from the appointment, and as my pain was growing, we stopped at a pharmacy to purchase the medication on the way home. But with little luck. “We don’t supply this medication,” we were told. Little matter, we drove to the next pharmacy a few miles away in Maryland, where my daughter trains to be an emergency medical technician. But since the prescription was in my name, and I am a Virginian, we again obtained no medication, but growing pain from my teeth.

Onwards then to Virginia. Yet here I was informed that the pain medication was a narcotic which in Virginia needed to be personally signed by the issuing doctor who, due to the holiday, had long ago left his office. Back to the car, with surging pain, we aimed for my home pharmacy where they know me. I always admonish my daughter to drive cautiously, but now I asked her to drive as fast as possible. It took 45 minutes, but finally, the home village came into sight.  About one kilometer before the town, we heard a horn behind us and saw a blue emergency light. It was a visiting state trooper who stopped us for driving at an excessive speed. I started to explain, but his gestures made me quickly recall the saying of ‘tell it to the judge’. Besides, I just wanted to get to the pharmacy.  

The trooper was quite meticulous, but 40 minutes later, we were on the road again. At the pharmacy,  we were immediately recognized and the prescription was, of course, filled right away. Apparently, word had gotten around regarding my earlier visits to other pharmacies since the pharmacist told me in confidence that ‘next time, just come here directly.’ The pills worked, and I thanked my daughter for her help, also promising to pay for all her expenses. In the end, the bills for speeding, lawyers, court cost, regular fees, speed measurement all added up to more than $ 1,300.

All this is truly not earth-shattering but of major impact nonetheless. Lack of collaboration may start out by discomforting life, but given time and repetition, can lead to growing social gaps.  America has, for more than one and a half centuries, principally drawn strength and a good life through success from its cohesiveness. Nevertheless, there have been shortcomings, apathies and neglect which require repair.

We must recognize and adjust our lives to cope with the growing complexity of the world today. Breaking up links and relationships is a bad idea. We continue to have an unsurpassed capacity for communication and analysis. We can find ways that allow for curative marketing or restitution for past or current wrongdoings. There clearly is room for improvement, be it for pain pills, jurisdiction, or treatment of people. Let’s take steps for the pursuit of happiness, which supports us all.– the Declaration of Independence has made a promise, but we as individuals need to deliver on it.

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Professor Michael Czinkota (czinkotm@georgetown.edu) is emeritus faculty of international marketing and trade at Georgetown University. His forthcoming book is International Business, 9th edition.

International Health Care of the Future: The Evolution of the Doctor-Patient Relationship

By: Michael Czinkota and Anna Astvatsatryan

Is it possible to make high quality medical care affordable to everyone? Finding the “golden mean” in health care is a hot topic of discussion. Patients and governments both agree that health care needs to be effective, accessible and affordable. The search for a balance pushes advocacy groups to seek unconventional solutions. New technologies may offer easier access to providers and allow medical experts to review patient complaints. Globalization is said to open doors to geographically more diverse and therefore less expensive treatment options. Can new technologies in new places really make a difference in the field?

Patients often find their own solutions. International medical tourism, where patients travel to low cost medical locations, to take advantage of cheaper health care services, has grown exponentially. Many countries such as Israel specialize in certain treatments; others emphasize their low costs of health care across the board. According to “Patients Beyond Borders”, an international medical tourism association, Brazil, Costa, Rica and India are among the top medical tourism destinations. The top specialties for medical travelers include cosmetic surgery, dentistry and cardiovascular surgeries such as angioplasty and transplants.

Researchers and advocates in the US are looking for solutions to keep their patients inside the local medical care market by offering alternative medical treatments. The Washington Post reports about a study by professor Rashid Bashrur of the University of Michigan that focuses on telemedicine – virtual medical care when doctors study and advise their patients remotely. This study shows that telemedicine, the use of medical information exchanged from one site to another does matter. It can reduce the length of hospital stays and numbers of emergency visits, and provide remote connection between doctor and patient. Telemedicine technology can reduce the health care costs for patients and increase the speed of conversation between patients and medical experts. Yet increased virtual medical care can also lead to more frequent appointments with nurses. In an international context virtual healthcare may be used as an alternative to medical tourism. The main considerations are language and communications barriers that can occur between doctors and patients. Lack of communication will not play a big role if the patient is a child, but may cause trouble with older generations.

New automation technology will convert a growing number of health care providers into technical experts. That tendency is quite visible in orthopedics, where large efforts and resources goes into the development of prosthetics. In 2006, the Defense Advanced Research Projects Agency, part of the Defense Department, launched a $120 million prosthetics program. Another aspect is the effectiveness of the new technology where analysis of large volumes of data will provide new research tools for the medical experts. Such an approach may, however exclude much of the “human factor” from healthcare. Another issue is the pricing for such kind of “technological” medical care. What should be the price difference between an actual doctor and nurse and a beeping computer?

New technology can also make medical treatment more holistic. Currently, after a diagnosis and a prescription, doctors typically do not have much control over a patient’s behavior. It is up to the patients to decide to take the prescribed medicine on time and in the suggested dosage or not take it at all. The use of automated systems can control the treatment process. Companies such as EvaStarMedical, Cytta and Microchips, which I advise and in which I hold stocks, are very promising firms. They have begun implanting chips with drug reservoirs in patients. These chips can be implanted directly under the skin, delivering doses of pharmaceuticals or birth control hormones at the same time each day. The implanted chip is designed to be remote-controlled and governed by medical professionals whose expertise is in technology rather than medicine. This technology will help older patients that tend to forget to take their medicine. It will also decrease the workload for many health care providers. Is it necessarily a good thing? It may disemploy some physicians, but can also be viewed as a fundamental industrial change. Gutenberg’s invention of the printing press is a great example of technological progress and its consequences, when a new and effective technology of printing basically left monks and other document copiers jobless. On the other hand, new medical technology will eliminate a great deal of person-to-person communications. Most of the patients, especially the older folks, need and value good bedside manners. Research has shown that patients who feel that their provider has good bedside manner are more compliant with treatment regimens, have more positive health outcomes, and are more satisfied with the care that they receive.

The main question remains if patients actually want to save money on health care in exchange for a medical system with minimal interpersonal communication and very limited face-to-face meetings. Are patients ready for a medical system where the doctor knows all about them but still very little of them?

Professor Michael Czinkota (czinkotm@georgetown.edu) teaches International Business at Georgetown University in Washington D.C. His main text is “International Marketing, 10th ed.” Published by Cengage. Anna Astvatsatryan is a graduate student working on a degree in Communications. Originally from Armenia her professional work is in the fields of marketing and international business.