Sunday, March 15, 2015

Futuristic Medicine

I just deposited a check into my bank account by photographing the check with my iPhone and zapping it through cyberspace.  I realize this is a yawn to the under 35 crowd.  Soon, there won’t be any paper checks as the entire transaction will occur electronically.  As a member of the over 35 crowd (plus 20 years), I am wowed by this process.  I remember being astonished when my kids told me how they performed this same process a year ago.   It’s the same amazement I experienced when I first read about a new piece of technology called a ‘fax machine’.

"You mean you slide a document into a machine and an exact copy emerges elsewhere?"

In my younger days, depositing a check into a bank account meant waiting in line with my bank book in hand waiting for a living, breathing human to count and record my allowance and snow shoveling earnings.   The bank that my kids use today has no physical offices.  It is entirely in the Twilight Zone.

Medicine will not be left behind here.  The manner in which medical care will be administered will be beyond what we can imagine.  We are seeing glimpses of it already, but our vision of its trajectory is limited.  There will be huge advances, but as with all technology, there will be a cost.  The traditional doctor-patient relationship will fade out and will no longer be the bedrock of medical care.  There will be nostalgia for it from those who experienced it, much as I have warm memories of bank books, rotary phones, ice cream sodas and playing basketball after school in the school yard.

Find this phone in the Twilight Zone

I’m sure there is technomedicine going on today that I’m not aware of and would amazed me.  Smart phones and their derivatives will become medical routine diagnostic tools.

Easy stuff

  • Tell Siri your history and send a photo of your rash to DERM APP and prescription will arrive at your door in 1 hour.
  • Place phone on your chest and cardiopulmonary data will be forwarded to your cardiologist who will transmit medication adjustments to you electronically.
  • Shine beam of light through a urine specimen which will confirm if urinary tract infection present.
Hard stuff

  • Coronary bypass surgery performed robotically by a surgeon in New York City on a patient in Abu Dhabi.
  • Artificial organs created in 3-D printers.
  • Miniature cameras journeying through the digestive tract, circulatory system and major organs delivering customized treatment for various diseases.
  • Smart phone analysis of saliva sample which will screen for risk factors for 20 common chronic diseases that will have effective preventive strategies.
  • Satellite delivery of yet to be discovered form of radiation to the developing world which will decimate food borne illness.
  • Patient will place his palm on a glass and an electronic signal will be transmitted to internal organs whose function needs adjustment to treat disease or preserve health.
I still use a stethoscope.  It's not a collector's item yet, but I don't think it will be much longer. 


Anonymous said...

One thunderstorm or one beaurocratic whim and your records are gone. Obsolete or trendy new software will make reading old records impossible.
nothing is a durable as paper.
And more secret too.

JPC Ph.D. said...

I never quite know what to think when I read articles on the "death of the doctor-patient relationship." Some years ago now, in the early 2000s, an MD/MBA whiz in our area established a multispecialty practice that has been growing leaps and bounds. His group was the first in the area to use laptops in the exam rooms etc. People wept about the "impersonal" nature of it all, and the founder was interviewed in a local media outlet as saying (and I'm paraphrasing it here) "Marcus Welby is dead, this is medicine now. Get over it." People were appalled.

My PCP is part of that practice, and a very early adopter of all things technological. He is also the most human, humane, and engaged physician I have ever encountered, before or after the technological revolution. If anyone knows well how to balance technology and humanity, it is this man, I wish I could clone him for everyone else to see that it's not just "get over it." Lest you think he is an anomaly, I have seen a half a dozen specialists in the practice over the years, some for a visit or two, some ongoing: gastroenterologist, orthopedic specialist, cardiologist, etc. All very young (well, in comparison to me). Every single one of them has known how to balance the relationship--admittedly, some better than others, but then again, not all docs were Marcus Welby types before the revolution either.

I am a bit amused that the hard-line, "get over it" mantra came from the top of this practice, and yet the front line docs are about as far from that attitude as can be. Perhaps I have just been lucky.

If your stethoscope becomes a museum piece in the coming age of medical wizardry, I don't worry that means that the human relationship will disappear. Those who want it to continue in conjunction with all the bells and whistles will find a way to make it so.

David M. Sack, MD said...

JPC Ph.D.has it right. Technology can augment and not detract from the human element. Unfortunately, the regulatory and economic factors are not keeping pace. So far the main technologic impact on medical practice has been the electronic medical record. Physicians like myself remain enslaved by medical record-keeping software that demands that we ring every bell and blow every whistle to document our encounter. Reimbursement remains irrational and "accountable care" is a long way off. Meanwhile we are working longer hours for less pay in the name of what is for the most part meaningless use.
I'm not worried about the impact on this physician's humanity, whether it is that of the laptop in my hand or the amazing technologies to come. I am worried about who will pay for it and how. We need single-payer health care, standard record-keeping software, and rational reward systems for those of us who have to do the adapting. No technology will provide the political will that is needed to encourage these changes.
Physicians must lead. We should be talking about this problem as vocally as about stool DNA testing for colon polyps.

Anonymous said...

"Coronary bypass surgery performed robotically by a surgeon in New York City on a patient in Abu Dhabi."

Actually if for-profit care has its way it will be coronary bypass surgery performed robotically by someone, who might be a surgeon, in some third world country on a patient in New York City.

Michael Kirsch, M.D. said...

Comments appreciated. I surmise that if most physicians were queried, they would agree that medical technology has diminished the doctor-patient relationship. I suspect that most patients, particularly those who are at least 50 years old, would agree. Many are quick to champion the advantages of techno-medicine, while ignoring or glossing over the costs, many of which are intangible.
@David, who had the courage to sign his own name, I admit I have a visceral hostility against single payer, but I'm not informed or smart enough to offer the solution here. I did not support Obamacare and its implementation and future direction have not dislodged my view.

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