Now is a fascinating time to be in medical school for a number of reasons. One reason is that we constantly hear how medicine is changing by leaps and bounds. We often hear that less than half of what we are taught will still be true by the time our careers are over. Over the last decade as the smart phone has exploded and digital connectivity is constant, we’re often made to wonder how technology will impact the experience for the physician and for the patient.
The most common and most “Star-Trek” question is, “Will computers replace doctors?”
In a wonderful debate with a professor of mine here at Stanford, Dr. Abraham Verghese, Vinod Khosla claims that “80% of what doctors do can be replaced”. You can watch the debate yourself here http://youtu.be/-kersW3tuLQ. Khosla argues that machines are better at analyzing data and delivering the correct decisions. Everyone wants the best care, and computers and algorithms will be improved in the very near future to provide better (more evidence-based) decisions than many if not most or all doctors. This is especially true when you consider areas with limited access to physicians or in areas where the quality of care provided is poor.
However, in his rebuttal of sorts, Dr. Verghese hits the nail on the head, but I don’t think Khosla quite catches it. Verghese points out that “75% of our healthcare costs in this country are spent on chronic illness, and the diagnosis is not an issue for the patient or the physician…most of the time the diagnosis is not the issue; it’s caring for the patient in a manner that takes them through this suffering that is really the issue.”
Khosla is right, computers will be able to do diagnosis better than doctors, but diagnosis isn’t the core problem with American healthcare. By my estimation it’s probably more like 5% of the problem. When you look at our healthcare system, the problems are access, quality, and cost. These are systems level issues: making sure someone who needs care can be seen and get an appointment; making sure the bandage that is supposed to be changed three times a day gets changed; and increasing efficiency and making sure people aren’t ripping off the system for huge paydays. We absolutely need technology to fix these problems, but little doo-dads that diagnose an ear infection aren’t the solution to the fundamental issues in health care, they fix smaller problems around the periphery. I think the big fix to our healthcare system will come in ensuring follow up and follow through on the decisions we already make.
Fixing smaller problems around the periphery is still a good thing, but it’s important not to pretend that with these neat little ventures we’re addressing the core problem. Atul Gawande once wrote an essay about how. wherever in the country you go, when you dine at a Cheesecake Factory restaurant, the salmon is always going to look and taste pretty much exactly the same. You can enter the restaurant, expect what you’re going to get, and have a quality product delivered to you at a reasonable price. Addressing the core problems in healthcare means doing the same for the healthcare system.