FUTURE OF MEDICINE, AND IT DOESNT LOOK BRIGHT
I read an article this month in Fortune Magazine about the future of medicine. In The Doctor will See you (and your Data) Now, David Agus, MD writes about ways technology will change the practice of preventative and primary medicine. The article is based on his recently published book called The Lucky Years.
Do it your self fetal monitoring – smart watch EKG – he isn’t just imagining what could be, he is writing about technology that exists today and celebrates how this kind of data can and will be used by physicians to care for patients.
He writes, with a seemingly hopeful tone that the “whole notion of going to the doctor when you are sick may change.”
I admit, that I do not share in his enthusiasm for this future. When you spend your days (as my entire office does) hearing tragic stories of misdiagnosis, death, pain and avoidable injury, you begin to form rather distinct options as to whether technology is the answer to the call for better medical care.
Imagine a woman 25 weeks pregnant who thinks she has heart burn., but the pain is so intense she cannot sit or lay down without panic creeping in She turns on her smart watch and her blood pressure is elevated, but only slightly. The App on her phone, based on some pre-arranged algorithm, her heart rate and blood pressure, says to rest now and re-measure later. She tries though the pain is worsening and eventually falls asleep. Hours later she wakes up vomiting, feverish, in pain so great she can barely dial the phone.
It isn’t hard for me to imagine this scenario because it reflects my own condition years ago. Thankfully, I didn’t have a smart watch to advise me or recommend a course of action. Instead, I had a team of emergency room physicians, 9 hours of laboratory data, an OBGYN with over twenty years of experience, and an ultrasound that found my organs were enflamed, swelling and I needed to deliver my child at once or both of our lives were in danger.
Sure, there is room for technology in medical care. There is a need for it. My Doctor’s office yesterday texted to confirm an appointment. My daughter’s pediatrician checks and responds to email. Doctors can access online information from UP TO DATE while completing a patient’s medical chart. Physicians can discuss a difficult case on a list-serve and share experiences with various medications. Electronic medical records can provide history when patients are often forgetful of medication changes, symptoms and history.
But do we want Rosie from the Jetsons to diagnose and treat acute abdominal pain? Will she know to ask about food allergies, recent stress and anxiety? Will she see the rash developing on a patient minutes before anaphylactic shock causes her airway to swell?
Count me as a skeptic, but I hope the future of medicine doesn’t eradicate or end physical contact between physicians and patients. Sure, data is useful. But so is taking the time to examine the whole person when providing medical care.