Wednesday, January 13, 2016

Even doctors are threatened by automation

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?



Rev. Paul said...

"I wonder how well they'll work with bullet holes in them, put there by infuriated calorie-addicted consumers?"

I don't know, but hereby volunteer to help find out. :)

sth_txs said...

Odd don't you think with all this technology, that the only things that keep costing more is education, health care, and housing. Oh wait, that's where government interferes the most.

Russell Newquist said...

Even software engineers are threatened by automation. It's just that most of them haven't figured out yet that they're in the process of putting themselves out of work by automating everything.

Anonymous said...

Engineering / Architecture as well are getting more automated. CAD (Computer Aided Drafting) has been around quite a while, but CAD programs such as Revit are able to do a lot of the work more efficiently, making alterations on the drawings much faster. Meaning less Architects / Draftsmen / Engineers are required to do the construction documents.

libertarianrn said...

PA's are not "basically, specially trained nurses...." The role is significantly different. An RN is focused on assessment, medications administration, and physical cares. A PA is focused on diagnostics, prescribing, and medical intervention. You don't want a PA trying to do a nurse's job, and you don't want an RN doing a PA's job.

An RN will generally have an associate's or bachelor's of nursing. Some have added a masters degree also, but these tend to be focused more on research or administration. A PA will generally have a master's.

Nurse Practitioners are RNs who have completed an additional master's or doctorate level program to add diagnostics, prescribing, and medical intervention to their scope of practice.

I don't feel my job particularly threatened by the development of technology. People are bad about managing their health now, and the deficit is not from a lack of resources. Diabetics have all the resources they need to manage their health, and yet we still see people come in to the ED with blood sugars over 1000. While young, tech savvy people may manage their health with these tools, that population makes up a very small percentage of those who regularly use the health care system.

Will said...

That wearable data sensing tech needs to be available in the ER right now. A couple years ago, I had an irregular heartbeat, (caused by an over-the-counter- cough medicine). Tied up a room for six hours, just to be connected to a max lead EKG system. That should/could be a fannypack sized unit I could have worn while sitting in the waiting room, or wondering the halls.
It was a Friday evening, and busy! Outside my doorway, I could see a guy on a gurney, who had been hit by a vehicle while training on his bicycle. That six hours cost me over $4k, to tie up a bed for no other reason than that was where the equipment was located.

Bob Mueller said...

I'd like to see more automated vital signs reading and monitoring, especially for diabetes patients.

As for Fitbits and other devices, I don't expect it to be too much longer before those are required in some way. Oral Roberts University is now requiring students (beginning with this year's freshmen) to wear a FitBit at all times. I'm wondering what they're going to do with the GPS data from those...

Javahead said...

I'm a software engineer, and I've got to disagree with this (and Russell Newquist's claim the our own jobs are being automated away).

Anything that's simple, repetitious, and easily quantifiable will be automated whenever it's cheaper/easier to do so than hiring someone: agreed.

Also agreed that there are some tasks in medicine (many specifically relating to billing or standards compliance) that fall into that category. Most of medicine either falls into the categories "requires both educated judgment and human interaction" or "requires hands-on physical presence", usually both. And many (most?) hospitals here in the US are already understaffed.

Engineering the same - most of the core tasks may be made more efficient by automation, but they still require considerable human interaction in understanding, balancing, and translating the requirements into something real. Now if you said that many technical job categories in the US are threatened by H1B visas and offshoring, you might have a point . . .

Rolf said...

Wow. It's almost like someone might think of inventing a tricorder or something. But if you have that, what did Kirk need Bones for?

Able said...

I both agree with both libertarianm and Javahead … and don't.

Most of the monitoring and tests we receive in GP's and hospitals is (excepting the 'high-end' MRI, CT, etc. types) already basic 'grunt-work'. It's the interpretation of the results you need a doctor for (and usually a specialist which your GP/Hospital doctor has to consult themselves). But, smart systems are already common in surgeries, hospitals and even in areas such as NHS Direct. All that is needed is an amalgamation of the testing and diagnostic.

Imagine you, your spouse, or child feels unwell. You 'plug them into' a home testing kit (maybe incorporating everything from questions, basic physical signs, bloods and other fluid testing to possibly even camera/thermal 'scans' - look at SpO2 monitors development for detecting shock to see the possibilities of amalgamating such technologies). The results are fed to a 'smart system'. You get a diagnosis (probably a number with percentage probability). You take an action/give a medication, call a doctor or head to an ER/A&E. Such a system would weed out almost every minor, common ailment long before accessing the health services.

The major impact on the health services will be … money.

Remember, the health services in every country relies on the masses of mostly healthy individuals paying out the same (and paying unreasonably high amounts for basic services to subsidise expensive ones at that) as the unhealthy so as to subsidise and pay for their care.

If you're managing all your minor ailments at home only needing 'catastrophic cover', much like car insurance, you'll expect/demand a major reduction in what you pay. (And even if you don't you wont be paying, as one has said, 4k for an ECG/EKG that you could have done, and had interpreted, at home very easily even now).

That'll force a major change in healthcare delivery right there. It's a Ponzi scheme, take out the majority of suckers and it'll collapse. I suspect for the better, only the necessary will remain instead of all the excess-funded bloat.

As for doctors? Most act effectively as nothing more than gatekeepers/middlemen – their roles would disappear overnight with such systems.

Jut my twopennerth

Clinton J said...

Captain Kirk's transponder looks pretty similar to my flip phone! I-Robot put the people on lockdown, for their own safety. While I don't see artificial intelligence happening any time soon, government controlled automation (robots) in our lives is a different horror film that I can believe!

Retired Mustang said...

As an RN, I feel compelled to point out PAs are not "specially trained nurses." The 2 professions, while both directed toward the health of patients, are not the same. Even Nurse Practitioners and PAs, while often functioning in clinical roles that appear similar, are not the same. One difference is that NPs, unlike PAs, are not required, depending on a state's Nurse Practice Act, to function under the auspices of a physician (though they surely need collegial relationships with them for referral purposes) Admittedly, this may only be of importance to PAs and RNs...