In my previous article, I had discussed some of the reasons why doctors seem to become less relevant as the science of medicine evolves. As data about different medical conditions becomes available on line, this data can be parsed and algorithms can be prepared on how to diagnose and treat almost any medical problem. Here perhaps a quick aside. The word algorithm is derived from “Algoritmi’, the Latinised version of the name of a Muslim mathematician, Musa al-Khawarizmi (780-850 CE)). Al-Khawarizmi also gave the world the word “algebra’ that derives from the title of his book: “Al-kitab al-mukhtasar fi hisab al-jabr wa-l-muqabala”.
As far as the different types of medicines available to treat different conditions are concerned, the number of these ‘therapeutic’ options is now so large that it is often difficult for any one person to keep track of all of them. Worse, different medicines can often interact with other medicines a patient might receive, and to remember all of the possible ‘adverse’ interactions is also difficult. For most physicians, modern computer ‘apps’ that can keep track of all this information are welcome.
The problem for physicians is that all these algorithms and other information on the Internet are also available to hospital administrators, paramedical staff, and even patients. As such almost any person with some computer expertise and a smattering of medical knowledge can access this information and even treat many diseases effectively.
Perhaps the ‘art’ of medicine based on physician experience is becoming irrelevant. This is not as bad as it looks. In the modern world, complex machines are now being designed by computer programmes. And computer generated human voices guide drivers to their destinations using the space satellite based Global Positioning System (GPS).
So then, why not a computer generated human voice to treat medical problems? After all a computer never sleeps and virtually knows everything that needs to be known. Also, modern technology is reaching the point where medical information including patient history and possible ‘tests’ can be performed and the information transmitted to a computer that can evaluate all this data to provide both a diagnosis as well as a plan of treatment. As it is, such methodology is already in place where human medical experts can perform a similar function from a remote location.
None of this means that humans are out of the picture in any of the scenarios described above. All these computer programmes and algorithms are designed by humans as is all the medical information that is produced and entered into databases to be parsed and utilised in different fashions. The evolution of technology has, however, had one important side effect. Much of medical and surgical development took place with animal experimentation that was often rather cruel. Computer simulations and programmes have markedly decreased the reliance on such experimentation.
Clearly many routine doctor-patient interactions can be replaced by nurse-patient interactions. Some of the basic medical prescriptions for common diseases that are easily treated can also be prescribed by pharmacists. If they are not available yet, ‘apps’ (applications) for many basic diseases like the common cold or diarrhoea might soon become available and can be downloaded into our smart phones. So, even ordinary persons can then use these apps to decide what they need to do.
But when it comes to non-physicians or ‘apps’ on cell phones, the major problem is not going to be medical but rather legal. If anything goes wrong who is ‘liable’ for this, the app maker, the nurse or pharmacist using these apps or the patient that treats himself. Other than the patient, all other providers of medical treatment have to function under the legal cover of a licensed medical practitioner who carries an adequate amount of ‘malpractice’ insurance. Pharmacists can only advise the patient about ‘over the counter’ medicines or suggest approved alternatives to prescribed medications.
Most diagnostic tests, medical prescriptions and virtually all surgical procedures require the ‘services’ of licensed practitioners. And the licensing authorities in most countries, including Pakistan, are made up of doctors. As long as doctors control licensing of medical practitioners, it is unlikely that doctors will be forced out of the loop of medical treatment any time soon. However, in countries like the United States (US) where medical care is extremely expensive, this system of medical licensure is under considerable pressure.
There are three important aspects of medical care as far as a majority of patients are concerned: availability, accessibility and affordability. In a country like Pakistan where a majority of the people live in or on the edge of poverty, these three requirements can be best fulfilled by a relatively inexpensive decentralised system of medical care where basic care is provided by ancillary medical personnel who can refer patients to area hospitals as needed. And for these poor patients the ancillary medical personnel will, for all practical purposes, play the role of physicians.
The question then is the role of ‘hands on’ physicians in the future of medicine. It seems to me that computer-based medical care is here to stay. In more advanced countries like the US, medical apps and algorithms will continue to determine much patient care. Such dependence will be enforced by those that pay for medical care and this includes the US federal government as well as private insurance companies. Uniformity of care decreases the cost of medical prescriptions and cuts down on unnecessary diagnostic testing.
To look deeper into the future of medicine, it is worthwhile looking at science fiction. Perhaps the longest running science fiction franchise is that of Star Trek. In the original series that came out around fifty years ago, the star ship’s doctor, Leonard McCoy played an important role. He was an adviser and friend to the captain, a well-informed physician and a caring human being. More often than not it was his caring or empathy that played a role in plot development. By the time the fourth iteration of the series, Star Trek: Voyager came around some thirty years later, the doctor had been replaced by a computer generated hologram.
This hologram was based on Artificial Intelligence (AI) that could grow and in time developed human characteristics that replicated those of an empathic physician. So, even in a science fiction environment that is situated in a distant future, it seems that besides expertise, empathy remains a basic requirement of a ‘good’ doctor.
Empathy is one aspect of the practice of medicine that cannot be replaced by computer-based medical care. Unless of course we develop AI that can learn and display human characteristics, some human input will remain a prerequisite for medical care. After all most of us want to be treated by physicians that ‘feel our pain’. But if so many people can talk to ‘Siri’ (Apple Computer’s interactive vocal programme for its smart phones) as if Siri is a real person then anything is possible.
The only possibility that could make doctors redundant is that science prevents all forms of disease, inherited or acquired and also makes sure that there are no accidents or other forms of violence. But then how are humans going to die?