“The doctor will see you now via your smartphone screen without an hour of waiting, at any time, day or night. It might not be your primary care doctor, but it will be likely be a reputable physician who is conducting part of his or her practice through secure video consults. And those consults will involve doing parts of the standard physical examination remotely. More importantly, they will incorporate sharing your data—the full gamut from sensors, images, labs, and genomic sequence, well beyond an electronic medical record. We’re talking about lots of terabytes of data about you, which will someday accumulate, from the womb to tomb, in your personal cloud, stored and ready for ferreting out the signals from the noise, even to prevent an illness before it happens”
Following on from the best selling Creative Destruction of Medicine Dr Eric Topol’s latest book The Patient Will See You Now is now available on Amazon/Kindle.
************UPDATE SUNDAY 4 JANUARY 2014************
At 18:00 on 8 January 8 2014 at San Diego’s Museum of Contemporary Art in La Jolla, Eric Topol MD will give a talk on the future of medicine in which he’ll discuss the opportunity to collect personal health data, share it and Video Consult with a Doctor with just your smartphone.
To register for your free ticket click here. For any questions email firstname.lastname@example.org.
All attendees will receive a FREE copy of the new book.
****UPDATE WITHIN 24 HOURS TICKETS WERE ALL TAKEN****
********UPDATE 8 Jan 2015********
Video clip from the talk:
“…this is not a big ticket item… …but why isn’t this moving faster? That’s because of the resistance of the medical community. This represents change, it represents challenge of authority that’s been around since 2600 BC… …the first Doctor was a Priest”
************UPDATE 6 Jan 2015************
Abigail Zuger MD has shared a rather scathing review of the book in today’s New York Times that’s well worth a read:
“Dr. Eric Topol and I appear to practice medicine on two different planets. This fact makes it difficult for me to comment sensibly on his books, let alone critique them. Instead, I read along with mouth slightly agape, marveling at this missive from a far-off place whose atmosphere, physical laws and inhabitants bear no resemblance to the ones I know.
Dr. Topol is a cardiologist who directs the Scripps Translational Science Institute in La Jolla, Calif., and also serves as editor in chief of the website Medscape. His title at Scripps, “Professor of Innovative Medicine,” says it all: Like a fundamentalist preacher heralding the apocalypse, he preaches the end of medicine as we know it and the dawn of rigorous, digitally perfected, accurate and cost-effective care”
I understand some of the criticism as I also have concerns about a mythical future where Digital Health is the Answer to Everything but this is a book about the future so we shouldn’t feel surprised if we find some of it challenging.
For me the criticisms are a reminder of how challenging many Doctors find it working in a technical era that is very different from the one in which they were trained and in which they are expected to continue providing undocumented care with an unviable funding model that hasn’t evolved from the 2000 year old sickcare model with it’s focus on producing ‘visits’.
I think the key that will make Topol’s latest book have more impact and be even more successful than his previous “Creative Destruction of Medicine” is that he now has a much greater appreciation of how healthcare is being impacted by Mobile (the newest mass media) and that this tool driven revolution will be the key driver that will force us to discover new things that cannot be explained never mind served by a Sickcare industry that struggles with even basic documentation:
Jumping to a few of the closing paragraphs and I think I see where the total disconnect exists for Dr Zuger:
“Finally comes the interesting philosophical question of whether all patients really do want — or, indeed, should want — to be their own doctors. You could actually write a book on that question, a book that might penetrate a little closer to the essence of medicine than Dr. Topol ever gets.
Certainly, people who are engaged in their own medical care fare much better than those who are passive and disengaged. But how engaged must a person be? When does engagement become burdensome?”
When you work within a system that involves forever trying to guess at what Patients want (how else do you think it’s possible to manage Patient needs while interrupting them before they’ve had 18 seconds?) it can become second nature to just presume you will always know what Patients want.
Within the Instant Medical History questionnaire that we utilise as part of the remote consults we offer at 3G Doctor a very revealing question that Patients can choose to answer is how much they would like to be engaged in their care. You’d be surprised how much better you can serve a Patient when you just let them tell you how much they want to be involved (I’d Never Admit That to My Doctor. But to a Computer? Sure).
Sick people have a primal need to be cared for; almost always, the sickest patients find that relinquishing the tough decisions to someone else brings huge relief. Healthy people may certainly enjoy monitoring their own physiology, but that activity can take up an awful lot of time. There are many wonderful things to do in this world other than keeping track of your own organs. Sometimes, it just makes sense to have someone do it for you”
I think here there’s a presumption being made that decisions need to be made by someone else (eg. a person and not a compassionately programmed computer that is always on, doesn’t need sleep, etc) and that sick people and their carers somehow find it easy to manage their healthcare needs using out of date tools that don’t even make sense to the born mobile generation.
Check out this post and it should be obvious that just integrating mHealth into how we care for diabetics (eg embedding a mobile phone into a glucometer just like Amazon did with their Kindle reader) we have created a significant step change because:
> the Patient no longer needs to remember when to test (the M2M glucometer device and/or their mobile phone will automatically remind them when it’s required).
> data (the dumb numbers diabetics with unconnected glucometers need to interpret and collect) is automatically turned into actionable information.
> decisions can be made whenever/wherever by the specific individual protocols that carers can set.
> advice can be found and questions can be asked (my simply opening the Diabetes Pal app on a mobile).
> ‘tracking’ becomes redundant because the process of collecting the data just becomes seamless.
************UPDATE 7 Jan 2015************
The media are showing a lot of love for Dr Eric Topol and this “The Future of Medicine” Huffpost Live interview by Josh Zepps really gets into some of the key challenges:
“JZ: you talk in the book about this being medicines Guttenberg Moment, what do you mean by that?
ET: well it’s really a remarkable parallel I think between the 1400’s when only the elite and the priest could access written materials and read, to now when now because of smartphones and all the medical information flowing through them generated by the Patients that they’re going to be able to read about their data and medical information really for the first time. So it’s a democratisation of information and now for medical information…
…(4min) so we’re an on demand I want it now culture and it’s now extending to medicine as well.
JZ: so we hear President Obama talk all the time about bending the cost curve of medicine and making this affordable because American medicine is wildly expensive, and we spend a huge amount of our GDP in this country on healthcare. I can wait two weeks to go and see my General Practitioner or I can force my insurance company to spend twice as much and I can spend twice the copay to go to an urgent care centre here in New York City, or if I use an app on my phone to get a Doctor to come to my house presumably that’s even more expensive. These are all fancy ways of doing things but can we afford a world in which we’re all doing everything on demand?
ET: Well the rest of our culture is getting that way and it’s inevitable that it will happen in medicine. There’s just no reason for these long waits. And it isn’t just the wait to get an appointment, then you’re waiting in the office reception room, and then finally you get into (the consult room) and you get this seven minutes with the Doctor (who is) typing at a keyboard. This is not the pinnacle practice of medicine! We can do better than this”
I think Eric has it spot on. Josh should check out the PatientCommando campaign from Patients who would like their Doctors to provide them with another 18 seconds before interrupting, or interview Roy Lilley’s 93 year old mother as he’d learn that this isn’t about finding fancy ways of doing things this is simply about using the tools of our time to think beyond the office visit and make things easier for Patients who face enough hassles without having to endure avoidable journeys and waiting room experiences.
************UPDATE 10 Jan 2015************
The comments thread provides a treasure trove of interesting feedback:
“Douglas Levene: Robin Cook wrote a great thriller about the future of Apple doctors, “Cell.” In it, [spoiler alert] the I-Doc software decided on its own to start culling the uncurable, and the authorities decided that was a good idea so they let it go.”
It’s not really that difficult to imagine this type of scenario developing if we let AI take decisions because there will be few (if any) people capable of winning the argument against a computer that can really on much greater resources and has time on it’s hands that clinicians don’t have.
To my mind that’s exactly why a book like #TPWSYN is so important. We need to have wider debate of these issues – an area that David Woods (@DW2) is doing great work on in the UK (see the call for feedback on his Tranhumanist Political Manifesto here).
“Sallie Smith: The problem with this type of medical care is that you have to teach the unteachable. You also have to have these devises available to the general population. How do you teach the person with the sore throat they don’t need to go the the emergency room. Then again with all of the technology it still won’t help the hypochondriacs. I guess that’s where the mental illness apps comes into play”
It stuns me how many people have this impression of hypochondriacs (eg. that it’s a mental health problem). The worst cases I’ve seen are Doctors and often it’s the result of the frustrations sensible Patients and Carers get when they’re forced to interact with a system that is designed for a different era at a time when they really need all the help they can get.
“Newell Everett: @Sallie Smith Some of us may be unteachable. But, there are generational transitions – the next one will grow up seeing & understanding technologies the oldies cannot, so will be more accepting of helpful devices”
“George Eapen: “I am in atrial fibrillation, now what”. That is the rub. All these carnival barkers for the utopian vision of the smartphone/connected world are simpy exhausting”
We treat it and help you avoid suffering a debilitating stroke?
“George Eapen: …For all it’s many benefits, the internet is rife with misinformation when it comes to healthcare and the burden is now shifting to the consumer to sort out what is real and what is bogus. The facebook that he cites admiringly in nothing more than a giant waste of time. Every few months we hear about the alleged effects of social media, yet Boko Haram did not release those girls because the First Lady hashtagged anything. Siri can find me useless information about dry cleaners when I am seeking information about crop dusting services. Just saying……”
I love SIRI (I’m ‘typing’ this with it’s Nuance Speech Dragon relative) but it’s important to appreciate it’s limitations. Dismissing it because of it’s current failures will cause us to miss the opportunity eg. imagine civilisation had ignored the printing press because in the early years the books weren’t interesting to a particular reader.
“Marcos Lujan: What human touch? Your waiting for the doctor in the waiting room & the examination room 20 or more minutes, and he’s done in no time flat. Dr. Abraham Verghese’s Ted Talk also gives some insight on the future of a doctor”
“DANIEL SCHROYER: This all sounds great except for a few little things like HIPAA, Obamacare, and CMS/insurance bureaucracy. Radical changes in gov’t policy are required for 5% of what is envisioned here. We are talking resistance worse than that for Uber.”
There will never be a better time to start talking about these issues.
“William Cheung: It’s a lot of marketing hype. All this tools can be confusing to patient. Just like information on internet, people thought they can be overnight expert on their medical problem, they are actually looking at the wrong place most of the time.”
The internet is radically changing the Doctor Patient relationship. Buy the book and read it and that will become clear.
If you have any doubt consider this one fact: Family Doctors here in Ireland no longer see croup (because mothers use the internet to understand and treat it)?
“Mary Alexander: The author is assuming a level of sophistication that the average patient does not have. Who will take responsibility for these masses? This also assumes the physical exam means nothing. Or the human element. He must be a highly paid consultant who has not seen a typical patient in years. Typical pompous academic/rich guy.”
Never dismiss Patients and their Carers. They will continue to amaze and exceed all your expectations if you care enough to take the time to listen to their stories.
************UPDATE 13 Jan 2015************
Seemingly nothing can stop Eric Topol’s blazing trail with the media (even during CES – the world’s biggest consumer electronics event – he’s been captivating the attentions of the world’s top tech news reporters) and yesterday it was NPR’s Nancy Shute who led with “Imagining A Future When The Doctor’s Office Is In Your Home“.
“Extracting medical care from the health care system is all too often an expensive exercise in frustration. Dr. Eric Topol says your smartphone could make it cheaper, faster, better and safer. That’s the gist of his new book, The Patient Will See You Now… …(BUT) won’t a lot of people be left behind because they can’t afford to do this or can’t manage the systems?
Eric Topol: “We’re talking about cheap stuff; smartphones you can get for $35 now from China. You have a cheap phone, you have mobile signal everywhere, pretty much, and you have very user friendly interfaces. My 93-year-old mother-in-law lives with us and she’s on her iPad constantly…
…We made this unbelievable switch from inpatient surgery to outpatient, so many operations are done now as an outpatient. So we did adapt. You can now do a stent as an outpatient in an hour. So that’s going to happen again. We’re going not from inpatient to outpatient but inpatient to home. Hospitals are going to need to become data surveillance centers. The data is going to be coming from the community, from the region”
Although I think we should be careful not to refer to mHealth as “cheap” (as it’s much better to talk about the incredible value that is on offer eg. £35 documented consults with registered Doctors) it’s another great read and the comments thread reveals many of the very real key challenges that Patients and Carers will face with mHealth:
“Mark Kropf: Whaaaaa…? I understand that a low risk patient with some chest fluttering and a fast heart rate with irregularity can have these examined while in the convenience of their home. Okay. I’m fine with that. The kitty can be fed, the home may not be robbed. One can walk about in undies or turn the Radio or Internet -You Tube – up full volume while doing Air Guitar at 3 AM without a nurse or fellow patients getting upset. And you don’t have to choke on (ugh) hospital food. But… Having an irregular heart beat with salvos of PVC s, an accelerated Idioventricular rhythm or, worse yet, Ventricular Fibrillation and well, what then? What does Dr. Topol do 4 miles or 40 miles away? What does one do with a Mobitz 2 Rhythm that progresses to Complete heart block? Does the patient put on an external pacemaker or does somebody anti-coagulate the patient and cardiovert him or her over the phone? Exactly what is the benefit of monitoring a patient if there are no facilities or equipment to act on the data? Duh”
Read this Biotronik sponsored paper and appreciate what is acheiveable when we just turn on the connectivity in cardiac devices that Hospitals and insurers routinely ignore today (not a properly designed mHealth solution with embedded connectivity like Telcare have created for Diabetics). Understand that the 2000 year old healthcare model is broken and no longer viable. Now try and think like a member of the born mobile generation.
The reality is that cardiac events like those ‘Mark Kropf’ is concerned about are probably happening today but we’re largely ignoring them and failing to understand their implications because there’s a complete lack of real time connectivity (eg. Patients who have battery powered implanted cardiac devices don’t know if it’s switched on or off or even the status of it’s battery yet they nearly all know the same about their mobile) or because everyone apart from the Patient (who typically just wants the best care) wants to avoid the medicolegal implications that come with accurately documenting healthcare, and because we’re completely failing to learn from other industries that leverage data to reduce the impact of failure and prevent problems developing (eg. the auto industries warning lights and ‘limp home’ mode that trigger long before engines are irreversibly damaged).
“Male Kimp: I’ll have to decorate it with drug company swag to make it right”
“SeaLady: Patients have to be able to develop medical skills, and anything that can aid them is a good thing. The fact is, doctors’ time has become so valuable to their employers that it’s quickly becoming worthless to the patients. The few rushed minutes you get with a doctor, after required waits of anywhere from twenty minutes to an hour or more, are increasingly not worth the effort and money, unless what’s wrong with you is easily diagnosed without thinking time and requires prescription medications or advanced procedures. But if you go into a clinic with something at all subtle, be prepared to leave no wiser than you were when you arrived. Learning to use the Internet intelligently for medical information is a must now. (Avoid dot coms–stick with .edu, .org, and .gov sites, and compare various opinions among them to come to a reasonable conclusion about what you can do for yourself.) Any consumer tool that can help is quickly becoming a necessity. I’m not saying the doctors are happy running a rat wheel to make money for investors, but many of them are stuck there, and the patients are increasingly on their own”
Thankfully Doctors are increasingly seeing the opportunity to break with the revolving door 5 minute unprepared and undocumented consulting model. Let’s hope more citizens have the clarity enjoyed by “SeaLady” and are supporting the forward thinking Doctors who are prepared to spend their invaluable time learning about new tech and putting it to work to extend the care they offer to their Patients beyond the four walls of their clinics.
************UPDATE 16 Jan 2015************
An interesting 25 min chat with Neil Versel (NV) in Forbes features something (from 20min into this podcast recording) that I find very revealing:
“ET: We need a Health Spring. We need consumers to activate and eventually we’ll get there. I mean…
NV: When you say ‘Health Spring’ you’re likening it to the Arab Spring that was driven by social media?
ET: and Smartphones
NV: and Smartphones yeah.
ET: Basically if it wasn’t for the Smartphone’s ability to you know to (capture) the photos the videos and all the other communications to get people revved up and you know we’ve seen that begin with the whole tragedy in Paris. That’s how people get activated today. We need something like that to happen like that in Healthcare. You know that’s one mechanism by which this will finally get capitalised and we can move forward”
It’s a bit chicken and egg but it’s important to realise the Arab Spring didn’t happen because of social media but because of mobile – the newest mass media – and the ability it afforded to access social media.
This might be hard to appreciate when you live in a broadband connected home with 5 TVs, a PC, Laptop and 2 smartphones but citizens in the Middle East weren’t primarily activated by social media websites but from the SMS and MMS messages that were sent to their inexpensive mobile phones (typically Nokias) by other ‘revved up’ citizens with their own inexpensive mobiles.
Evidence for this can be found by looking at the distribution of technology around the world (eg. the mobile phone is the ONLY DEVICE that beeches the digital divide and has MORE OWNERS in emerging markets) and how quickly many governments in the Middle East went about taking down and blocking/monitoring internet access because clearly these activities would’ve undermined attempts by citizens to share messages (and content like videos) back and forwards with websites like Facebook.com. Instead they were sharing them P2P via mobile networks and in person (think screen sharing, Bluetooth, SD Card transfers, etc).
************UPDATE 16 Jan 2015************
“Topol sees a future in which “your smartphone will become central to labs, physical exams, and even medical imaging; and . . . you can have ICU-like [intensive-care unit] monitoring in the safety, reduced expense, and convenience of your home.” This is a book full of technical wizardry and intriguing questions about the nature — and the future — of diagnosing, monitoring and healing”
************UPDATE 18 Jan 2015************
FoxNew HealthTalk’s Dr Manny talks to Dr Topol about how the future of medicine is at your fingertips.
************UPDATE 21 Jan 2015************
“…we’re never going to get away from Visits of course but the main thing that’s exciting now is that we have the opportunity to democratise medicine. The Smartphone will be the hub, there’s so much you can do with that phone whether it’s your sensors, your labs, summoning a Doctor, getting the costs for your care, all these different things it’s really going to be quite extraordinary…”
************UPDATE 23 Feb 2015************
“You’re calling for a revolution in healthcare, where you turn the Doctor Patient relationship upside down. Why? …Well it’s time for a major change [and] we didn’t have the tools for that until now and for over two millennia Medicine has been paternalistic and autonomous – the Doctor’s been in control the information flowed from the Doctor to the Patient but now because of the digitised way medicine and information will flow in the future largely through ones smartphone that that is empowering individuals in an unprecedented fashion and it’s Patients generating their own data that they’re going to see first through their own devices about their body and the vested interests they have in their health so this is a great inversion of medicine. It’s a very exciting time but it requires some pretty radical adjustments to let it happen“