Insight
Comment: Democratisation without compromising care
The necessity of experts for equitable healthcare, by Blanca Lesmes, CEO of BB Imaging and TeleScan

The large-scale adoption of telemedicine and the advent of artificial intelligence in healthcare have some of us very excited. These recent developments may be the very keys we’ve been searching for to unlock that holy grail of healthcare: democratisation.
What’s going right
Let’s check off some of the keys we’re holding. Today’s technologies:
- Offer patients and providers greater access to information while keeping it secure, despite the efforts of some bad actors.
- Enable the use of data in an intelligent way, enhancing our decision-making capabilities and enabling prediction and prevention.
- Extend and expand care, making it more available and accessible to underserved communities.
- Build engagement and empowerment in patients and increasingly make them our primary focus.
I don’t want to downplay this: there is so much to be gained by continuing down the path of healthcare innovation and democratization.
Likewise, I don’t want to downplay the very real possibility of these keys being misused to open a veritable Pandora’s box.
What could go wrong
Innovation has the potential to make the healthcare system more positive and effective for patients, but it could also lead to the compromise of high-quality data and compassionate care.
Let’s look again at our keys to see what we know so far:
- Sharing information inherently leads to less personal privacy, and while healthcare organizations try their hardest to keep data secure, bad actors are occasionally successful in stealing, selling, and misusing information. This leads to less trust in the system and its data.
- Artificial intelligence and machine learning don’t doubt their conclusions. We know that an AI fed enough of its own outputs may return nonsense. Mischaracterized and wrong information isn’t useful for decision-making, and again, erodes trust in the system.
- The technologies that extend care can also introduce more barriers to care. Digital illiteracy, a lack of Internet access, and resistance to change could exacerbate disparities instead of minimizing them.
- Compromising data and care quality diminishes trust and pushes patients further away from the care they need.
The master key
So, where do we go from here? How do we continue to democratize healthcare while refusing to compromise on the quality of that care?
We have one more key, and it’s the master key: We empower healthcare experts to lead the way.
No one is better positioned than our doctors, nurses, allied health professionals, etc. to effectively introduce and employ these technologies in their communities—and no one is better suited to their critique.
One example
I am the founder of TeleScan. Our software is the piece of the prenatal care puzzle that connects local providers with sonographers who are the best of the best. (I mean this literally. Our sonographers are among the most highly credentialed in the nation for the OB/GYN modality.)
When we first introduced TeleScan to the sonography community, there was a lot of resistance. Of all the misgivings I confronted, most were centered on patient care. Critics were worried about poor-quality images, missed anomalies, poor diagnostics, and a lack of compassion. These concerns are consistent with the risks we acknowledge above.
What turned this conversation around?
We showed skeptics that sonographers are involved at every step of care. They guide, provide feedback, and make requests of the local healthcare provider at the ultrasound machine during the exam. Humans skilled in ultrasound are still at the center of reviewing patient images and utilizing their experience and expertise to develop a report. More than 50 sonographers assisted in the initial product design, and several continue to provide our development team with constructive feedback. The result is a high level of quality that often surprises providers and patients.
This is only one example. I know many others have similar stories.
Unlocking healthcare equity
So, where do we go from here? My answer is we move forward—with one eye on our innovations and one eye on this important truth:
Keeping true expertise at the centre of innovation is what will keep patients at the centre of our healthcare system.
Written by Blanca Lesmes, CEO of BB Imaging and TeleScan.

Sponsored Content
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News
Women drove 71% of global health workforce growth since 1990 – study

Women accounted for 71.4 per cent of global health workforce growth between 1990 and 2023, according to a study covering 204 countries and territories.
The global workforce almost tripled over the period, rising from 40.9m to 122.1m workers.
Women represented 68.9 per cent of all health workers in 2023, but remained concentrated in professions that generally offer lower pay and fewer leadership opportunities.
The study analysed 20 groups of specially trained health personnel, including doctors, nurses, midwives, pharmacists, dentists and community health workers.
Between 1990 and 2023, the workforce grew by more than 81m people, including an additional 18.9m nurses and 8.7m doctors.
In 2023, there were 33.2m nurses, 15.1m doctors, 7.6m community health workers, 6.8m pharmacists and pharmaceutical assistants, and 6.1m dentists and dental assistants worldwide.
Women made up 80.7 per cent of nurses, 96 per cent of midwives and 89.5 per cent of community health workers, while fewer than half of doctors were women.
A similar pattern was seen in dentistry and pharmacy, where women were more likely to work as assistants than as dentists or pharmacists.
Megan Knight, lead author of the study and researcher at the Institute for Health Metrics and Evaluation, said: “Women have transformed the global health workforce over the past three decades, but they continue to be concentrated in professions that generally offer lower pay and fewer opportunities for leadership.
“Building stronger health systems will require not only expanding the workforce, but also creating equitable opportunities for career advancement, leadership, and safe, supportive working environments.”
Despite the growth, researchers estimated that an additional 34.4m doctors, nurses, midwives, dentists and pharmacists would be needed to achieve moderate levels of universal health coverage.
Universal health coverage means people can access essential health services without experiencing financial hardship.
The estimated global shortage includes 23.9m nurses and midwives, 7.1m doctors, 1.8m dentists and 1.6m pharmacists.
South Asia had the largest estimated shortages, requiring an additional 2.6m doctors and 10m nurses and midwives to reach the study’s benchmark for moderate universal health coverage.
Sub-Saharan Africa also had substantial shortages. Nursing density was estimated at 14.5 nurses per 10,000 people, compared with 121.8 per 10,000 in high-income countries.
At country level, there were 3.2 nurses per 10,000 people in Chad and 3.3 in Madagascar, compared with 171.7 in Belgium and 161.4 in the US.
Dr Annie Haakenstad, senior author of the study and assistant professor of health metrics sciences at the Institute for Health Metrics and Evaluation, said: “Health workers are the foundation of every health system.
“Although the global workforce has expanded dramatically, millions more doctors, nurses, midwives, dentists, and pharmacists will be needed to ensure people everywhere can access essential health services.
“These findings provide countries with minimum thresholds for planning the workforce needed to strengthen health systems and move toward universal health coverage.”
The study estimated that moderate universal health coverage was associated with minimum workforce densities of 23.8 doctors and 64.5 nurses and midwives per 10,000 people, alongside 5.2 dentists and 5.6 pharmacists per 10,000.
Researchers said closing workforce gaps would require continued investment in education, recruitment, retention and working conditions.
They also highlighted gender-responsive policies, including leadership development, workplace protections, paid parental leave and flexible work arrangements, as measures that could support a predominantly female workforce.
Insight
Women using performance-enhancing drugs face major gaps in healthcare support

Women using PIEDs reported difficulty accessing reliable information, testing and clinical expertise, according to a qualitative study.
Researchers interviewed nine women who used performance- and image-enhancing drugs, primarily to enhance body composition, physical appearance or sporting performance.
Participants reported problems accessing comprehensive blood and hormone testing and finding clinicians familiar with health concerns linked to women’s use of these drugs.
This has been a male-dominated area of research for a long time, so there are significant gaps in understanding women’s health care needs.
The research, led by University of Queensland School of Psychology PhD candidate Hannah Schuurs, explored how the women managed their health while using PIEDs, which include substances such as steroids and peptides.
Schuurs said: “We interviewed nine women who use PIEDs about how they managed their health throughout their PIED use.
“They reported difficulty accessing reliable information and a lack of clinical expertise and formal health care support.
“The study participants were all active in self-monitoring, tracking changes in their bodies, and actively sought formal health care support.
“But they found it hard to access comprehensive blood and hormone testing, or clinicians who were familiar with the unique health concerns associated with women’s PIED use.”
The study found participants spent considerable time educating themselves about the drugs and their potential risks.
“They often found themselves educating healthcare professionals rather than receiving guidance tailored to their circumstances.
Schuurs said: “The participants had spent considerable time educating themselves about PIEDs and their risks and found they were often educating their health care providers, rather than receiving guidance tailored to their circumstances.”
“Structural and systemic barriers shifted a disproportionate level of responsibility for harm reduction and care coordination onto the women themselves.”
Participants were also aware of sex-specific risks, including hormonal disruption and virilisation. Virilisation is when masculine physical traits develop due to high levels of androgens.
However, the women did not necessarily expect healthcare professionals to have all the answers.
Schuurs said: “Participants were often understanding of gaps in clinical knowledge, provided they were met with openness and a willingness to work collaboratively.
“They emphasised that respectful, nonjudgmental health care relationships were just as important as technical expertise.”
The findings also challenged stereotypes that people using PIEDs are uneducated or indifferent to their health.
Participants reported actively managing their health while navigating stigma, uncertainty and gaps in healthcare.
Schuurs said: “The participants actively managed their health and navigated stigma, uncertainty and gaps within health care.”
“We need health care responses that are collaborative rather than judgmental, as those narratives can oversimplify people’s experiences and make it harder for them to seek support.”
She said the research showed PIED use could form part of wider goals relating to health, wellbeing, performance and self-management.
Schuurs said: “Better understanding women’s experiences is critical if we want health care systems to respond effectively and ensure women can access the support they need.”
“There is a real opportunity to improve education, clinical guidance and support for health care professionals in this space that values and draws from the lived experience of women themselves.”
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