Forbes: “The Year 2020: The Doctor Will (NOT) See You Now!”

An interesting Forbes article by John Nosta, “a contrarian with a vision for tomorrow“, takes us to the year 2020 when he expects the smartphone rather than the Doctor to be at the centre of the healthcare experience.

My thoughts on the predictions:

computer-guided laser vision correction is so commonplace that eye glasses are hardly necessary and almost pure fashion. Except for the occasional “Google Glasses” that early innovators still wear as a badge of adoption

I’m also very optimistic about advances in ophthalmology and the mobile AR opportunity but I wouldn’t be so confident of this prediction. Not only do we have many people in the world for whom the cost will remain prohibitive but we also have an aging population and increasing levels of diabetes (diabetic retinopathy is the leading cause of adult blindness in a market like the US) that are unfortunately going to make this unattainable.

Today is the first time you’ve been to a doctor’s office in two years. Yet, surprisingly, you’re as compliant and up to date as can be. Over the past two years, you’ve had several interactions with your doctor including an ECG, simplified physical exam and evaluation of a sore throat. However, these evaluations were done from your home with one of the most essential components of care for both you and your physician–the smart phone

I think by 2020 the idea of “going to the Doctor” will include making informed video consultations like we offer here at 3G Doctor so the idea of staying away for 2 years would be a bad idea. Similarly the idea of doing an ECG once in the last 2 years is going to seem odd eg. since last year I’ve been recording my ECG several times per day and this tech will be native in smartphones by 2020 so you’ll be able to record an ECG every time you hold your mobile.

As you arrive, one of the first things you notice is that the waiting room is almost empty. Advances in digital appointments and off site care have changed the practice dynamics significantly

By the time this happens I think it’s obvious we won’t have a room called a “waiting room” anymore. We’ll have to rebuilt the clinic so it just has a corridor with more consult rooms coming off it rather like those Yotel pod hotels that are springing up in airports that have no reception areas (of course the glass will all be Samsung Smart Windows):

In fact, your family physician sees more patients virtually than in the real world

Of course there’s nothing “virtual” about video consulting but I love the quaintness of this idea that your 9-6 family physician will always be the person best placed to do this different type of work. It reminds me of how British Airways retailed tickets back in the 1990’s when you could watch staff going to work in their Regent Street store all dressed up in cabin crew uniforms so they could answer telephones!

The digital receptionist acknowledges you by first name as you approach this holographic image. Face recognition has instantly identified you and a thermal scan has checked your body temperature to screen for the potential of any infectious conditions that would immediately shuttled you off to an isolation area

Why would any of this be required? Why would we want holographic images to add such personalisation when we won’t even have waiting rooms for these receptionists and Doctors and Patients will already know why they’ve arranged to meet (we’ve been using such questionnaire tech at 3G Doctor since 2006)? Surely the smartphone in your hand will also have a thermal scanner (VitaDock already sell an accessory for your smartphone that does this)?

You pick up a electronic tablet and have a seat in the specific color color-coded, pod-like chair that the receptionist has indicated. There are some quick questions to answer on the tablet as electronic sensors built into the chair begin to analyze your weight, blood oxygen, and other key elements of your physiology

Why would I use the clinics “electronic tablet” when I already carry my phone and I’ve been able to complete questionnaires on it since 2006 (here at 3G Doctor)? I like the idea of a biomonitoring chair but why are Doctors going to want to use such an infrequent measure of biodata when you could just put this tech into/beside the beds we lie on every night (also something I’ve been doing for the last few years)?

You’re asked to do some basic tasks including standing, looking into a small scanner and to grasp two sensor handles. The analysis is compared directly with your electronic medical records and prompt questions about unusual changes or variations

When we’ve got a market for holographic receptionists (you can buy these already) surely we’ll be able to just video record ourselves doing this type of thing at our convenience and at home?

Once the basic analysis has been completed, supplemental questions–culled from an extensive clinical database–are asked to preemptively identify health issues and problems that can be address much earlier

Clinicians have been using this with their patients for over a decade. Dr John Bachman, Professor of Primary Care at the Mayo Clinic has published a paper on the safety and effectiveness this offers Patients and Doctors.

You might be surprised to know that most of your “history and physical” is now complete. An entire “healthprint” is on your physician’s desktop

A desktop????? In 2020 I think you’ll get a blank look if you talk about Desktops.

It contains a comprehensive physical exam that has been cross indexed against your past history and a large data-base of patients. Any outlying concerns can be address the good old fashioned way. But leaving that up to the unpredictable and error-prone abilities of a nurse or doctor can be problematic!

I always think it’s funny that so many futurists think we’ll all just be so happy and willing to put our trust in whoever it is who puts the database together. I imagine in many people this rose tinted future will exist until the computer tells them that despite being totally symptom free they need to have an invasive procedure, willingless changes quite quickly when you realise your fate is completely in the hands of a computer.

Perhaps the author hasn’t experienced a patient who has refused a treatment despite acknowledging it would probably be for the best but the story is very different when the patient can’t afford the treatment that the computer has calculated that they need.

Looks like you’re doing great!” Those are the first words you hear from an actual human–your doctor. And you’re done. On your way. But as you leave you can’t stop and wonder if this “carwash” type doctor visit is sub-optimal. What happened to the face time and human component of good old-fashioned medicine?

I don’t think this will happen but I do think Doctors will increasingly specialise in mathematics so that they can make better statistical understandings to enable them to be of more value to their patients in evaluating the best course of action.

Let’s take a closer look at what just happened in the future: It took 17 minutes–from start to finish. It’s effective and efficient

That’s the biggest mistake this author has made. Good health will never be something we do in 17 minutes. Our free will is what makes the other 525,583 minutes of the year so important to our health.

The analytical and diagnostic accumen of the technology is, in many respects, superior to the physical skill set of your doctor

Since the invention of point of care tests this has been the case. Today you can now do much of this stuff on your own eg a few $’s gets you a urine test for adrenal insufficiency, bilirubinuria, calciuria, fluid intake, glucosuria, Hematuria, hypoaldosteronism, leukocyturia, Nitrituria, phenylketonuria, phosphaturia, Proteinuria, pyuria, renal failure, etc.

But this doesn’t mean the end of Doctors but a redefined role where they start working from a more informed perspective eg. call centres that don’t know who you are (eg. the NHS’s £100 million per annum NHS Direct service) won’t make any sense but remote informed Doctors (like we have here at 3G Doctor) will make more sense than ever (it’s been obvious to anyone on the frontline that this was happening for sometime now).

The data used for diagnosis and therapeutic recommendations are always current and reflect the best and brightest thinking in medicine

Agree, but we’ll have much wider appreciation of the fact that science is often wrong and that we’re continually trying to work out what is the best, who is the brightest and what invested interests others might have.

The depth and breadth of the database used for predictive information is massive. No individual physician can ever have the experience, intuition or processing power to come close. The human touch is still there–it’s just reserved for more specific and valuable use

MIT’s Professor Cummings talked about this point in her recent TedMed 2012 talk. I personally think a lot of people making this claim don’t understand the work of a Doctor eg. a Doctor often keeps patients from actually getting “healthcare” or going into hospital and while this might seem to be something computers can do very easily (eg. a computer COULD read all the data and send a SMS to the patient saying “do not go to hospital”) that’s not going to be welcome or necessarily heeded by a patient who might be suffering with severe pain at 4 in the morning.

Check out this post for why we don’t need technology we need technology AND Doctors.

Healthcare is in a great state of transition now. Financial concerns, reimbursement and coverage, and an aging population will be powerful drivers of change. Technology will be a beacon of innovation that will help address many of these concerns without the compromise of care. The innovation, and the rate of change is simply amazing and the future is looking very healthy indeed

Couldn’t agree more but can only see this transition expanding the need for patients to see their Doctors whenever and wherever (the complete opposite of the articles title) and by the time that we do start getting near to retiring frontline Doctors you’ll be reading about it in an algorithmically created Forbes.

About David Doherty
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5 Responses to Forbes: “The Year 2020: The Doctor Will (NOT) See You Now!”

  1. Pingback: Forbes: “The Year 2020: The Doctor Will (NOT) See You Now ... | Australian ehealth |

  2. Pingback: Forbes: “The Year 2020: The Doctor Will (NOT) See You Now ... | Mobile Health Care |

  3. Pingback: Forbes: “The Year 2020: The Doctor Will (NOT) See You Now … | mHealth, HCSM & eye care

  4. Pingback: Forbes: “The Year 2020: The Doctor Will (NOT) See You Now ... | prediction |

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