“20% doctor included”: Speculations and musings of a technology optimist

Healthcare today is broken. It’s the result of approaching medicine according to practice and tradition, rather than real science primed by statistically validated data and conclusions.  Healthcare must move away from the system of small trials and experiential evolution of best practices to a state unencumbered with the conflicts of interest that currently lead to suboptimal results. Doctors today are doing the best they can given the current system, but we should embrace the new opportunities ahead of us.

Technology will reinvent healthcare as we know it. It is inevitable that, in the future, the majority of physicians’ diagnostic, prescription and monitoring, which over time may approach 80-percent of total doctor time spent on medicine, will be replaced by smart hardware, software, and testing. This is not to say 80-percent of physicians will be replaced, but rather 80-percent of what they currently do might be replaced, leading to new possibilities and functions for the physicians.  Healthcare will become more scientific and more consistent, delivering better-quality care with inexpensive data-gathering techniques, continual monitoring, more rigorous science and more available and ubiquitous information leading to personalized, precise and consistent insights into a patient. Disease will be measured not by the symptoms it creates but objectively evaluated by the metabolic pathways or physical parts it affects. Many new findings will be outside the reach of most physicians because of the volume of data and the unique holistic insights that data will provide about a patient’s very complex condition. Hundreds of thousands or even millions of data points may go into diagnosing a condition and monitoring the progress of a therapy or prescription, well beyond the capability of any human to adequately consider.

This evolution from an entirely human-based healthcare system to an increasingly automated system will take time, and there are many ways in which it can happen. Today’s traditional approaches will get better as new approaches, and even new medicine, is invented. The remaining 20-percent of physicians’ work will be AMPLIFIED, making them even more effective, and allowing even the average physician or nurse to perform at the level of the very best specialists. Doctors will be able to operate at substantially improved levels of expertise in multiple domains, and they also will be able to handle many more patients. The primary care physician and maybe even the nurse practitioner may be able to operate at the level of six specialists handling six areas of care for one patient with multiple comorbidities in a more coordinated and comprehensive manner without inter-specialist conflicts. This transition will affect each group of actors in the current system differently. Some constituencies will be affected favorably in some dimensions and worse in others, but the net benefit will be substantially positive for society and individual patients.  It is likely that a focus on science, data, and personalization will lead to plenty of unintended benefits that we cannot anticipate today. Nurses will be made much more capable by technology, often replacing the functions only doctors perform today. New medical insights, including ones we cannot yet envision, will be commonplace, and the practices we follow will be substantially better validated by more rigorous scientific methods.  Though medical textbooks won’t be “wrong”, the current knowledge embodied in them will mostly be replaced by much more precise and advanced methods, techniques, and understandings.

My statements are not forecasts that the hospital burn unit or emergency department will run without any humans on staff. Though the early changes will appear underwhelming and clumsy, by 2025 they will seem obvious, inevitable and well beyond the changes we might envision today. Expect today’s expert doctors to think these changes are implausible when they are asked about this possibility, and expect the classic response of “human judgment will not be replaced by technology” from people who are not qualified to judge what software technology in 2030 might be capable of.  The role humans will play in this is hard to define exactly but I suspect strongly that their role in healthcare will change materially.  It is possible that a much more cooperative system leveraging both humans and technological systems in their respective strengths may also evolve, as proposed in the book Race Against the Machine, but the core functions necessary for complex diagnoses, treatment, and monitoring (as a significantly expanded function of healthcare) will more than likely be driven by machine judgment instead of human judgment.  In fact, as Atul Gawande pointed out, some studies showcase that “our attempt to acknowledge and deal with human complexity [in human ways] causes more mistakes than it prevents.” [1]

The transition will happen in fits and starts along different pathways with many course corrections, steps backward and mistakes as we figure out the best approach. Given the importance of having clarity on what I hypothesize as my forecasts, I want to be clear that they are only directional guesses rather than precise predictions. Further, though many different disciplines will contribute to the innovation in medicine like biological research or new device development, I am mostly concerned with the contributions of digital health technologies to medical innovation. This should not be underemphasized, as these contributions, though potentially the most significant, are also the most variable, and hardest to predict in direction, timelines and scope.  The other sciences will continue to contribute much more fundamental insights into human well being...

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