Thought Provoking / Societal Innovation

“20 Percent Doctor Included” & Dr. Algorithm: Speculations and Musings of a Technology Optimist

By Vinod Khosla on

Healthcare has a radical opportunity to reinvent itself.  Healthcare today often results in suboptimal patient outcomes despite doctors doing the best they can within the current system.  Suboptimal outcomes result from the incomplete knowledge and personal biases of today’s system. Medicine has historically been approached according to tradition – the experiential evolution of best practices, and a reductionist system of small trials.  Optimal treatment outcomes require a healthcare system that is instead primed by holistic, scientifically, probabilistically or other statistically-validated data and conclusions presented to patients as cost/benefit choices. It is time to move beyond the stethoscope, which remains the iconic diagnostic tool for most healthcare professionals worldwide, 200 years after its invention.

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 doctors’/internists’ 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 so the roles doctors/internists play will likely be different and focused on the human aspects of medical practice such as empathy and ethical choices.  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 (across doctors) 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 that enhances human judgment will take time, and there are many ways in which it can happen. Likely the next decade will mostly see systems providing “bionic assist” to physicians and complementing or enhancing their skills. Today’s traditional approaches will get better as new approaches, and even new medicine, is invented. As the 80-percent of physician work is replaced over a few decades, the remaining 20-percent 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 friction. This transition will affect each group of actors in the current system differently. Internal medicine will be transformed to the greatest extent. Procedure-based medicine may take longer due to the nature of the surgical art, and procedure-volume based incentives. 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.  Projects like the Cancer Moonshot will apply rigorous genomic, proteomic and phenotypic tools and within large trials, to optimize the inadequate patient outcomes in oncology practice today.  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.

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