Will Doctors Be Needed in the Future?

There’s a big discussion going on in the health tech community about a controversial keynote speech given by Vinod Khosla at the Health Innovation Summit (HIS), in which he stated that 80% of what doctors do could be replaced by machines.

If you’re a doc like me who has no idea who the heck Vinod Khosisa is (he’s a venture capitalist and co-founder of Sun Microsysstems), why he’d be a keynote speaker at a healthcare event and what the heck HIS is, well, that’s the point of this post.

You see, there are a whole lot of folks like Khosia out there – investors, entrepreneurs, tech types – who are attempting to redefine healthcare according to their own personal vision.  Where we see a healthcare system in crisis, they see opportunity – just another problem with a technological solution.  Computer-driven algorithms are the answer to mis-diagnosis and medical error, IPhone apps can replace physician visits, video connectivity can increase access.

Where we see illness and distress, they see a market.

And what business folks like to call disruption in the marketplace. Think about what happened to downtown small town USA after the first shopping mall opened. Or what happened to movie houses when Netflix started offering DVD rentals online. Or where all the independent bookstores went when the first Borders opened up, and what happened to Borders when the Kindle hit the market.

Out with the old, in with the new.

If  Khosla is right, the we docs in our offices and hospitals are the old downtown department stores, the bookstores and the bricks and mortar businesses in an online revolution.

We’re replaceable. At least most of us.

Is Khosla right?

Maybe.

The therapeutic relationship between a doctor and a patient can never be replicated by an IPhone app. Not when so many of my patients leave my office on a daily basis telling me how much better they feel just having spoken to me. It’s a powerful and sacred relationship that is irreplaceable.

These days, however, almost all of my patients have googled their symptoms, and many have done a over the counter diagnostic test or treatment  before coming in to see me. I’ll never see the ones who got their questions answered online or their symptoms cured by that over the counter med – I see what’s left after self-diagnosis and self-treatment has failed, or google told them to see me.

That’s disruption, isn’t it?

One day very soon, women will be able to screen themselves for cervical cancer and std’s using a self-administered vaginal swab. No need to see me unless the test is abnormal, or there are symptoms.

Disruption.

Of course, computer driven diagnostic algorithms, apps and programs can create a whole new set of problems in over-diagnosis, since “there’s nothing seriously wrong with you” is rarely an output.  In my office, that’s a very frequent clinical assessment. Functional ovarian pain.  The occasional errant menstrual cycle or missed period. Anxiety. Stress. Depression. Lack of sleep. Over-eating, over-drinking, over-medicating.  What computer is going to pick that up?

Not to mention trauma care, surgery, childbirth, respiratory distress and any one of thousands of health emergencies that you can’t treat with an IPad.  I don’t see any of that work going away for docs anytime soon, do you? Some of it, of course, is being shared with trained non-physicians, and even robots. But docs are still an indispensable part of the healthcare mix.

So while the mix is changing, we docs are still in it. And I don’t see that changing. At least for here and for now. But the future?

I don’t know.

Docs need to be part of the digital revolution

I do know that if this is the new revolution in healthcare, we docs better get in on it.

Take the EMR as an example of what happens when docs let non-docs innovate in healthcare without significant physician input. We become typists, not physicians. Clerical work that used to be done by lower paid staff – entering lab and radiology orders – becomes ours to do. We spend the majority of a patient visit looking at a computer screen and not the patient. Retrieving relevant clinical information is like searching for a needle in the haystack of required fields of entry, most of which are not necessary to provide care.

Indeed, we have not yet shown definitively that EMR’s improve outcomes.

And yet we’re all using them, aren’t we?

If we are not part of the digital revolution and leave it to the venture capitalists and entrepreneurs, they will develop products that may sell, but if they don’t improve outcomes, all that will have been accomplished is a disruption in a marketplace.

Wouldn’t it be so much better if we could disrupt disease?

The real opportunity in Healthcare Innovation

There are millions upon millions of folks – some in American, but most in the undeveloped world – who have never had, and will never have the opportunity for a patient-physician therapeutic relationship such as that I’ve described above. They have no one to call when Google tells them to “talk to your doctor”.

But the overwhelming majority of the do have cell phones. Amazing, really. We can’t get indoor plumbing modern contraception or malaria tents to those in need, but 80% of folks in the developing word have cellphones. If that’s not an opportunity and a potential market for healthcare innovation, then nothing is. If we can get any healthcare into the hands of these folks, even if it’s healthcare delivered by a mobile app, we have the potential to improve their lives.

Now, imagine that we docs were able to free ourselves from the 80% of our work that can be replaced by technology, and then redistributed ourselves (virtually and personally) across the globe where we were truly needed, so that we could provide needed healthcare to the entire planet?

Now that’s disprution.

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7 Responses to Will Doctors Be Needed in the Future?

  1. Sounds similar to education, where there are a lot of people seeing a market and potential profit, and hoping they can introduce massive efficiencies and thus turn a bigger profit.

    We’re both in areas where intensive knowledge and information exchange is central, and where efficiencies of scale are hard to come by, really.

    But just as we’ve had libraries with all the calculus information anyone could want available widely in the US, few people are really good at teaching themselves calculus, so while most people could go to a library and get the Merck index, look up symptoms, and figure stuff out, they’d have a hard time really solving a problem.

    Both areas are under extreme pressures, and both will change drastically in the coming years. And in the long run, well, I’ll be dead anyway.

  2. i use dr. google so i can know enough to ask intelligent questions of a real doctor. (and i have better than average BS sensors on medical issues, so quite a lot of dr. google goes directly into the cyberspace circular file.)

    the thing is — dr. google is not going to ask me questions about what else is going on — i’m pretty sure i do not always have all the right questions, and i know for sure that some random [to me] things might line up medically in a way i can’t anticipate. and dr. google is not able to look at something and say it’s OK, or say we need to look into this.

    also, it creeps me out that entrepreneurs with no medical training think they can create algorithms for everyone to self-diagnose.

  3. Here is truth spoken to power: “The therapeutic relationship between a doctor and a patient can never be replicated by an IPhone app. Not when so many of my patients leave my office on a daily basis telling me how much better they feel just having spoken to me. It’s a powerful and sacred relationship that is irreplaceable.” We may not call you every day thereafter to say they still feel better! But we do! Maybe more of us should drop our doctors a note saying, “Feeling good, thanks to you!” This is mine to you–cross posted to facebook. But here on TBTAM, I’ll add that I don’t care WHAT Vinod Khosia says, no way I am putting my iphone….

  4. I Don’t think that Doctors can ever be replaced. Patients put so much trust in seeing the doctor as a PERSON. I see it everyday! The doctor-relationship is key in a patient feeling safe, secure and taken care of.

  5. This very morning at at staff meeting I saw an demonstration of our hospital’s new robot. It will allow “coverage” of the ER by a remote neurologist when ours is away. The guy was in his car on the Interstate by way of a cellphone and camera. Supposedly he can evaluate folks with stroke through the robot….but never touch the patient. Now maybe I’m a luddite, but that’s just plain creepy.

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