With ironic timing, I'd no sooner written about the threat to truck drivers posed by automation than a British newspaper points out that the same threat now confronts striking British doctors and medical personnel.
For all the medics' rage though, a new contract is the least of their worries. They face a far greater threat to their bargaining power not from politicians but from technology. Wearable technology and smartphones, to be precise.
Maybe you got a FitBit or other "activity tracker" for Christmas. They're all the rage – tiny computers you can strap to your wrist to count the number of steps you take, how well you sleep and even your pulse. Or perhaps you have a pedometer app on your smartphone.
By some estimates, one in ten people have used some sort of "self monitoring" device to track their health, a figure that will only grow. And as it grows, technology will change fundamentally the way we manage and maintain our health.
By necessity, the Department of Health is already thinking hard about how self-monitoring could change the way the NHS works.
Its focus is on getting patients to observe and report on their own conditions, especially chronic ones. As much as 70 per cent of the £110 billion [about US $159 billion] NHS budget is spent treating around 15 million people with long-term and essentially incurable conditions such as diabetes, pulmonary disease, arthritis and hypertension, all of which will grow even more common as we become collectively older and fatter.
The King’s Fund, a think-tank, estimates that people with such conditions now account for about 50 per cent of all GP appointments, 64 per cent of all outpatient appointments and fill 70 per cent of all hospital beds.
Many of those GP appointments are for routine monitoring, checking vital signs and updating records; many of the hospital admissions arise when that system of monitoring fails to spot problems approaching.
Instead of taking up the time of a highly-paid medic, why not let patients, using the appropriate technology, report their own data remotely? Real-time reporting would lead to better (meaning more preventive) care: live data-streams can highlight a patient's emerging problems earlier than sporadic short appointments with a doctor. A recent American review of 52 studies of people with blood pressure problems showed that those who measured their own pressure at home had better results than those whose levels were checked only by doctors. And spotting problems earlier means fewer costly and traumatic hospital visits.
But saving money for the NHS is just the start. Wearable technology could do much, much more for healthcare.
To see how much more, look at the work of Dr Eric Topol, who runs the Scripps Translational Science Institute in California, which studies how technology can improve medicine. The title of his book, The Patient Will See You Now, perfectly captures how the relationship between doctor and patient will change dramatically, and for the better.
In the near-future he describes, patients use smartphones and personal sensors to do things including screen their own blood chemicals and carry out advanced scans including electrocardiogram tests.
If that sounds far-fetched, consider pregnancy testing. Until the 1970s, only medics had the means to confirm pregnancy. Now the answer to one of life’s biggest questions can be found on a plastic strip sold in every chemist. And a smartphone can do so much more: you can already buy ultrasound scanners and ECG sensors that display results on your phone.
Inevitably, technologically-empowered patients will have a very different relationship with their doctor than the one common today.
Why would you meekly request to see the doctor then accept whatever course they recommend when you have so much information at your disposal? Treatment and management will become a conversation between equals where patients make informed choices and take real responsibility for their own health; the concept of “doctors’ orders” becomes unthinkable.
. . .
Being the only people who know about our health has made doctors wealthy and important, so it would be understandable if they had reservations about technology that threatens to overturn their monopoly on medical wisdom.
And from a self-interested perspective, doctors would be right to resist this trend too, because it has one striking conclusion: fewer doctors. This is the eternal story of technology and labour. New equipment and techniques allow each worker to do more work, to be more productive. And when each worker is more productive, employers need fewer of them.
There's more at the link.
We're already seeing physician assistants - basically, specially trained nurses - performing many routine medical examinations, prescribing drugs, etc. There's no reason why they can't report to an artificial intelligence system rather than a human doctor for all routine matters; and, in due course, there's no reason why even they can't be replaced by an artificial intelligence system in their turn.
Next step: robotic health care 'minders' that try to physically restrain us from eating that last donut, because it'll be bad for us. I wonder how well they'll work with bullet holes in them, put there by infuriated calorie-addicted consumers?