Simply put, we cannot dilute the doctor over and over again, until there is no visible trace of human physicians in our digital health brew of healthcare.
For decades and decades we have been counting the number of doctors in America. For decades and decades we have been coming up short compared to other developed nations, and some less developed ones as well. A poorly educated person may be tempted to suggest that we should “make” more doctors. After all, there is hardly a shortage of young people willing and able to undergo the rigors of a medical education. But luckily we are not poorly educated, so we devised much smarter solutions. If people can’t get a doctor appointment, it must be the doctor’s fault. Hence, we put our foot down and mandated that doctors see people the same day they want to be seen, or shortly thereafter. It sounds great and it worked perfectly for the Veterans Administration (VA), so it should scale terrifically to everybody else.
Taking a page from the highly respected Samuel Hahnemann, we decreed that physically “seeing” an actual doctor is not only completely unnecessary, but it may very well be detrimental to the healing process. A doctor effect is created by simply having an MD somewhere in the building, and as technology continues to improve, a virtual doctor presence should do the trick. Some have argued that Mr. Hahnemann’s homeopathic fantasy is no better than a placebo, but we have plenty of research showing that placebos are indeed effective. More importantly, unlike Mr. Hahnemann’s distilled water base, our technology solvent is very potent on its own merits. Imagine how successful homeopathy could have been if they used whiskey to dilute whatever the hell they are diluting.
As infallible as our highly educated reasoning may be, there is resistance to its widespread adoption, both from rich doctors who don’t want to see their gravy train derailed, and from simple minded herds of patients who are failing to grasp the infinite power of virtualization. We certainly can move, and are moving, forward with our powerful solution, but it would be easier and more humane, for all parties involved, if the barriers to change could be swiftly eliminated.
Barrier One: Our Doctors
The anachronistic habituation of people to seek help from a doctor when experiencing physical, and sometimes mental, pain and anguish, is perhaps the toughest problem we are facing. There is a bilateral dependency between physicians and patients which must be disrupted. People who tend to the sick and people who are sick refer to this phenomenon as the “patient-doctor relationship”. Our most immediate task is to impress upon the uneducated masses we are protecting that this relationship is one of abuse, exploitation and misplaced trust in professional conmen (and women). Hundreds of thousands of doctors may be scoffing dismissively right now, and as they do, we are half way there already.
The art of the smear goes by the name of “news” or “research” in our instantly connected tabloid society. In a country with a million degreed physicians it is easy to find a rapist, an arsonist, a thief, a drug dealer, a murderer, or any other criminal individual, who happens to be a doctor. Once we find those individuals, the hyperjump to general statements about a group of people is easy peasy, as long as our grouping of people is not along gender, race, ethnicity, religion or sexual orientation lines (except white men who are fair game).
The formula is deceptively simple: find a handful of criminal doctors, write a big exposé about doctors and pepper it with sex, money and drugs stories, add instructions on when to call the police “for, say, sexual or physical abuse”, package it all in a not-for-profit (previously) respected container, and wrap the whole thing in menacing pictures with menacing headlines (preferably all caps, large red font), such as “DOCTOR COULD HURT YOU”. And then you reinforce the message with a constant barrage of civic minded initiatives to address the fear you want to create. We must measure and rate doctors. We must have more transparency. We must improve care, or rather the experience of care (subtle, but big difference). We must take back control over our own health (from those overbearing, overentitled, perhaps criminal, money grubbing doctors).
Will it work? Can an irresponsible and sleazy messaging campaign in service of greed and avarice, overcome centuries of earned trust? It will take time, but look at the “truths” that became “evident” over time. Our teachers are incompetent. Labor unions are destroying our way of life. Police officers are racist murderers. And since the “democratic” election season is upon us, Bernie Sanders is a sexist communist like Guevara or Castro, and Donald Trump is a sexist fascist like Mussolini or Hitler. All you need is a concerted and sustained effort of money and media (a.k.a. “New York values”), which contrary to another artificially generated truism are not controlled by “the Jews”, but are run by a global cartel of egomaniacal sorry excuses for human beings.
Barrier Two: Our Expectations
Over the last hundred years or so, medicine has achieved almost miraculous success and in the process it changed our expectations. We expect to have malfunctioning organs replaced. We expect to not die of HIV and other infections. We expect to live free of pain and even free of wrinkles. We expect tiny babies that fit in the palm of our hand to grow up and go to college. We expect many cancers to be cured. We expect crushed bones, open arteries and charred skin to be fixed. And we expect to have a “good doctor” for all of the above.
These expectations, prevalent throughout affluent Western societies, pose a huge problem for the global money cartel. The Earth is flat, you see, and there are billions of people in this world who have no such expectations, billions of people who produce the finest iPhones, the trendiest footwear, the fanciest apparel, every single computer in the world, and are grateful for the privilege. If this mass of third world laborers begins to develop similar medical expectations, financial calamity is sure to rise from the Earth’s flatness all the way up to Mount Davos. It is therefore imperative to reduce medicine to something free or nearly free that can be easily distributed across the scorched plains of humanity.
This is where our technology solution comes in. Google is dreaming of connectivity balloons while Facebook prefers drones as the means to connect billions of laborers to the mobile virtual reality we all partake in. Having Google makes you feel educated and well informed. Having Facebook makes you feel connected, important and well liked. Having virtualized health care will make you feel healthy and well cared for. And it’s all free, infinitely abundant and available equally to all, regardless of socioeconomic condition. The Internet is your friend, your confidant, your teacher, your counsel, your entertainer, and now it will be your doctor, because the Internet knows you better than you know yourself, is there for you when no one else is, misses you terribly when you stay away, and cares for you as nobody cared for you before. The Internet is you.
You are controlling your information, your social interactions, your opinions, your shopping, your wealth (or lack thereof), and now you should take control of your health (or lack thereof). You can bank with the Internet without tellers and financial advisors, you can buy stuff without cashiers and sales associates, you can learn without teachers, you can fix a toilet without plumbers, you can manage your business without accountants, and you will manage your health without doctors. You will have all the tools at your fingertips in the comfort of your home (or trailer, or hut, or sidewalk under a bridge). You will no longer face the inconvenience and outright danger of going to an antiquated, flawed, rude and dishonest doctor. You will get health services that you and the Internet value most, and much, much more, because less is always more.
Barrier Three: Their Technology
As the two previous barriers are disintegrating before our eyes (or screens), we have one last barrier that is painfully real. We don’t have the technology to hack the doctors. We are certainly talking up a big game while scrambling to put something together that at least looks at first glance like the real McCoy. We talk about tricorders and artificial intelligence. We talk about deep machine learning and veritable oceans of omniscient data. We talk a lot about robots, genomes, bloodless tests and iPhones that deliver intensive medical care. But we have no idea how to mix the doctor solute into the virtual technology solvent to generate the coveted solution we put forward as fait accompli.
Technology in its current state cannot absorb and distill, let alone replicate, highly variable processes that lack both a clear starting point and a predefined endpoint. We don’t know what we don’t know, and in spite of flowery rhetoric, computers can only perform, and can indeed improve upon, tasks we fully understand and are able to precisely codify down to the most minute detail. Simply put, without an atomic level understanding of clinical decision making, we cannot dilute the doctor over and over again, until there is no visible trace of human physicians in our high tech brew of health care. We can however abstract a coarse approximation of relatively straightforward scenarios at the low risk end of the clinical spectrum, and advertise aggressively that the Southwest Airlines or its evil younger cousin Uber of medicine has arrived.
Here is the watershed event to watch for: the first FDA approved app that will diagnose, prescribe and deliver medications to your house by secure drone. It may initially be confined to over the counter stuff, but once that is mainstreamed, simple meds like antibiotics, high end antacids, allergy pills and such, will certainly follow. Next up will be staples such as simvastatin, Lisinopril and metformin, first the renewals and then a slew of new diagnoses of pre-this and pre-that. At the high end of disease, “precision” medicine will isolate one or two rare scenarios that affect one in a million people, script them and execute them flawlessly once or twice without physician intervention. Then we declare victory and spread the gospel to every $5 mobile phone from Guizhou province to the Appalachian Mountains to the banks of the Ganges river.
Médecine sans Médecins
There is no doubt in my mind that we shall overcome the first two barriers at very short order. There is no doubt in my mind that even if we fail to hack doctors in the abstract sense, we will be hacking the medical profession to pieces in the most physical sense. And there should be no doubt in anybody’s mind that whatever these cheap hacks are doing to our health care, the effects will not be apparent for decades, and even then the results will be attributed to the inevitability of external factors such as cultural change, climate change, famine, wars, migrations, solar flares, or random disturbances in the Force. Three centuries later, it looks like John Dryden had it right after all, and “God never made his Work, for Man to mend.”
Margalit Gur-Arie is the founder, BizMed. She writes regularly about the intersection of healthcare & technology on her site: On Health Care Technology. Follow her on Twitter at @margalitgurarie
Opinions expressed by HIT Consultant Contributors are their own.