Let’s be real. In New Zealand, as with most of the rest of the world, customer service is not one of the public health sector’s strong suits. Waiting rooms that truly live up to their names, rushed appointments, expense, and all for an unavoidably hit or miss diagnosis? From a consumer point of view, it’s a mess.
Futurists, developers and even doctors are beginning to say that the day really is coming when flesh-and-blood GPs will be the exception, rather than the rule, as we usher in a new era of data- and algorithm-driven medicine.
One of the more vocal of that group is billionaire Dr Vinod Khosla who has been setting the cat amongst the pigeons for the last few years, controversially declaring that the moment is rapidly approaching when smart hardware will replace 80% of general practitioners.
Image: Vinod Khosla, courtesy James Duncan Davidson/O'Reilly Media, Inc.
The Sun Microsystems co-founder says that healthcare should be, but isn’t, driven by quantifiable data. Instead he says, modern medicine is little better than “witchcraft and just based on tradition”.
The time has come for change, he says, and as technology moves forward in unexpected ways, expect resistance from the old order.
“Though the early changes will appear underwhelming and clumsy,” he says, “by 2025 [the new technology] 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.”
He’s got a point. If the medical industry isn’t due for an innovation overhaul, what industry is?
And Dr Koshla’s vision of the future might be closer than we think. IBM’s Dr Watson computer, famous for having beat the best Jeopardy! contestants in the world, is now diagnosing real patients at Sloan Kettering, New York. The machine is smart, having already analysed 600,000 pieces of medical evidence, two million pages of text, 26,000 clinical cases and completed almost 15,000 hours of training. IBM now claims that Dr Watson can successfully diagnose lung cancer at a rate of 90%, compared to a rate of just 50% for human doctors.
Dr Larry Norton, Deputy Physician-in-Chief at Sloan Kettering says Watson’s value is in allowing those with little training to make higher-level decisions in the absence of a licensed practitioner.
“What Watson is going to enable us to do is take that wisdom and put it in a way that people who don't have that much experience in any individual disease can have a wise counsellor at their side at all times and use the intelligence and wisdom of the most experienced people to help guide decisions.”
So the technology is useful for empowering semi-trained staff to make better diagnosis, but what about self-diagnosis?
That’s a question the XPRIZE looks to answer, with its challenge to developers to put a sophisticated diagnosis tool – think the Star Trek ‘tricorder’ – in the palm of your hand. The organisation is offering a $10m reward to anyone who can make a working copy of McCoy-approved device capable of diagnosing 15 medical conditions sans a health professional.
Image: The XPRIZE looks to create a real working version of Star Trek's iconic diagnostic device, the 'tricorder'.
The CEO of XPRIZE, Dr Pete Diamandis, says that he expects someone to succeed within five years and that, once that occurs, it’s only a matter of time before most diagnoses are performed by machines, not doctors.
“It’s a matter of providing the computer with the data,” says Dr Pete Diamandis. “Once it has the data, it’s able to consider thousands or millions of times more parameters than a human can hold in their head.”
While surgery is still firmly in the domain of flesh-and-blood humans, technology is empowering those surgeons to do more, with the 3D printing of body parts, merciful training simulators and the ability to perform operations with greater accuracy and flexibility than anything imagined so far.
Intuitive Surgical’s da Vinci machine, a device from which an expert surgeon can perform near-perfect keyhole surgery, has already been used in this country, performing less-invasive and far more sophisticated prostatectomies than otherwise possible.
Michael Mackey, New Zealand-based urologic and robot-assisted surgeon says that though the ‘r’ word is thrown around a lot, actual automated surgery is still a long way off.
“What we’re doing is still not really robotic,” he says. “It’s computer assisted surgery, and the surgeon is still in control. The day might come when there will be a ‘tie-a-knot button' for example, but as for the overall control of it, that’s not in the near future.”
“Still the most important factor is the [surgeon's] skill. At the moment it’s all about facilitating what the surgeon can already do, because the technical elements are often not that difficult, but it’s everything else that is important. It’s problem solving – those judgements about what to do if something goes wrong – that’s the stuff that’s difficult to replicate.”
Image: The da Vinci surgical robot
On a smaller scale, demand for self-administered, day-to-day monitoring and assessment is growing, at least if app development and uptake is anything to go by.
Doctor-on-demand provides patients with a live consultation with a real-life doctor on their mobile device, while Ask a Doctor allows customers to conduct near-real-time Q&A sessions with multiple physicians. Myriad apps allow ‘patients’ to test and assess themselves, performing such functions as blood pressure tests, vision tests, heart rate monitoring and mental health assessments. iBreastCheck sets up a reminders, and offers advice for self-checks.
The controversial Dr Khosla knows an opportunity when he sees one too, putting his weight behind the iPhone heart monitor attachment AliveCor, as well as Cellscope, a smartphone app that turns smartphones into a microscope that can be used to test for ear infections.
Many GPs have their reservations however.
“There are some things that may never be codified or driven into algorithms," says GP and author, Dr Davis Liu.
“Call it a doctor's experience, intuition, and therapeutic touch and listening. If start-ups can clear the obstacles and restore the timeless doctor-patient relationship and human connection, then perhaps the future of healthcare is bright after all… I know healthcare can't simply be solved by smart people in Silicon Valley alone. To solve healthcare we need everyone to collaborate.”
While the robots may be a way off, some, such as the Medical Council of New Zealand, are quietly optimistic about the potential of the technologies such as telemedicine, albeit with certain caveats.
“The concept of telemedicine is a fantastic one that potentially offers benefits to both patients and doctors alike,” said council chairman, Andrew Connolly, earlier this year.
“But it is important that both patients and doctors are aware of the pitfalls of undertaking consultations on the internet…a diagnosis made purely online, without a physical examination has the very real potential to be wrong.”
Regardless of concerns, the Ministry of Health is pushing ahead, announcing the implementation of infrastructure towards the National Telehealth Service, which will launch November 1st, offering phone, text and online support for patients.