What medicine will be like 20 years from now

I was asked recently to predict the practice of medicine in 20 years. After stating that any such prediction is massively speculative, I indulged because it is massively fun.

I am persuaded by Clayton Christensen’s arguments in The Innovator’s Prescription that healthcare will go the way of other massively disrupted industries, wherein healthcare will follow the arc of decentralization.

Using the music industry as an example, the arc begins by requiring consumers to go to Carnegie Hall, to buying players and music in stores, to eventually using a mobile device to purchase and listen to music in the back of a taxi. Similarly, much of the publishing and retail industry have traced this arc. It is only a matter of time until healthcare does the same.

Here’s how I think it’ll be done within the next 20 years.

Most of what goes on in a doctor’s office will be carried out by Eric Topol’s legions of wireless devices measuring our blood chemistries, heart function, vital signs, and many more parameters that modern medicine isn’t yet even currently aware.

All these devices will be networked with a central database and processing unit, a machine that goes bing. This machine will correlate this real-time data with the information riches of your own genetic profile. More than just you, this data will be meshed with several other informative contexts: your family’s genetic information; your friends and neighbors who share your environment; the demographics that enjoy your lifestyle. Last but not least, this machine that goes bing will be continually updated with the latest findings the medical science world. (It might have a lot to do with Archimedes Outcomes Analyzer.)

With some beeps and whirls, it will churn through data streams that would overwhelm the most cognitively capable of today’s doctors.

In twenty years, the patient with diabetes, the victim of congestive heart disease or emphysema, all will have their medicines optimized and managed (your new meds arrive in your mailbox … will we have mailboxes?) before their diseases advance to a point that today’s medical system would even notice.

And yes, just as we get our music from our pocket devices instead of needing to go the music hall, we will get today’s medical care from our personal devices without having to go to the doctor’s office.

Before you jump down my throat for predicting the demise of the medical profession, hear this: I do not predict the demise of the medical profession. While I do think that the practice of medicine as we know it today will be largely irrelevant, doctors in the future will be doing fantastic things that we can’t conceive.

I’ll leave it to someone else to speculate what that’ll be. Instead, I’ll cheerfully admonish against the assumption that technological growth will leave us all milling about with nothing to do.

Aaron J. Stupple is a medical student who blogs at Adjacent Possible Medicine.

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  • http://pulse.yahoo.com/_XDXG5WM7OC7I5IIR7GF7SAA2LA JohnG

    Problem – “central data base …???” really – seriously?
    The major problem we have with “Evidence-based Medicine” per se is the very nature of the shifting sands on which said database is to be founded upon.
    Much of the dogma from my medical school days in the 70′s is quite antiquated already, and we keep seeing new dogma dealt in and out with each generation of studies, setting aside the apparently growing or at least more appreciated issue of investigative fraud.
    A secondary issue is the apparent willingness of educators and regulators to lessen the educational and technical basis required of those directing and providing medical care, despite the huge growth in the depth and breadth of the information base itself. One of the major concerns is that it takes a depth of knowledge to recognize the limits of your knowledge and when to apply which “protocol” – and that is not oft appreciated.

    I do concur in the likely decentralization of information-gathering technology – bedside and exam room facilities for much of the routine and exotic diagnostic tools may be forthcoming – but will bring with them a plethora of regulations likely to blunt their effectiveness – can you spell “CLIA”…I no longer can spin it and look, or stain it and peruse, etc – even a stool card requires…(you know the rest…). I would like to have some home technology capable of reinforcing the fact that the common cold is just that, some method for helping the new Mom in deciding ill from cranky babies, and methods of home diagnosis of common UTI’s that would allow for direct treatment with less hassle (a common father of girls plea…).

    Good luck, Aaron – your presence in this media indicates wide interest in being involvemed…but remember that the best of medicine is in the one to one interactions of the average day; don’t get locked in on the apparent attraction of the aggregate.

    • Aaron James Stupple

      The shifting sands are precisely why we need the central database, so we can continually update it. I mean, it’s unfortunate that the sands of evidence keep shifting, but do we have anything better to go on? It’s easier to update a database than a textbook.

      I think the protocols are in place because we don’t have the continual monitoring that we’d prefer. For example, CHF exacerbations are prime targets for protocols, but if continual monitoring could prevent CHF exacerbations before they get going, and therefore keep them out of the hospital, then those protocols won’t be needed. In short, in my vision many protocols are moot.

      I am indeed interested in being involved, thank you for the encouragement, and thank you for taking the time to read this post!

  • Ybi Girl

    “In twenty years, the patient with diabetes, the victim of congestive
    heart disease or emphysema, all will have their medicines optimized and

    Yikes, hopefully NOT!

    Patients will be rewarded for “good behavior”, as determined by constant blood chemistry monitoring, through lower insurance costs and other incentives. Blood sugar issues will be a thing of the past with ketogenic diets taking center stage to minimize epigenetic issues and maximize brain health. With insulin and leptin issues solved through strict dietary programs, the obese percentages of the population have fallen dramatically and CHD is likewise a small blip on the medical radar screen. Emphysema, well that one may take a little longer to solve, but one can dare to dream, right?

    • Aaron James Stupple

      I love the optimism! Curious to hear how CHD turned into a small blip, though. Is it the diet thing, with the epigenetics? Or the insulin leptin bit?

  • http://www.facebook.com/brianpcurry Brian Curry

    Oh, sweet. Now that the quants have brought the world economy to its knees, they’ve decided to move on to health care.

  • eric_Lf

    Imagining a future for healthcare is the easy bit. The picture proposed here is credible, but the real question is how to transition from now to some defined future. A huge array of forces are arrayed against change in whatever direction. Just for starters: the political sensitivity of the main regulators, who get terribly beaten up with every major drug safety issue ; the rise of payers who demand value for money ; the increasing lack of imagination or the pharma companies ; the privacy concerns regarding medical data ; and worst of all, the huge lobbying power of the conservative wing of the medical profession. To the optimists who think that the IT giants would clean up house and force restructurings, the announced closure of Google Health deals a significant blow.
    So is it all doom and gloom? Not necessarily. Healthcare cannot indefinitely suspend the laws of business. Demand (for better health) has to be fulfillled eventually, even if the impressive forces fighting tooth and nail against change will do their very best to delay the inevitable. The sad thing is, if the rate of innovation sustained in less sensitive industries (like communications) had been emulated in healthcare, we would all be living longer and healthier lives.
    When there is a high underlying force meeting lots of resistance, frictions accumulate and can only be released through the equivalent of earthquakes: fast and painful disruptions. There clearly is a case for such disruptions to happen in health, but the combined strength of the resistors should not be underestimated. Instead of 20 years, it may take 50 or even 100 years for significant changes to happen in the way we think about medicine, pill-popping and diagnosis.
    On this topic, I recommend the excellent scenario report from the OECD. It can be downloaded for free at http://www.oecd.org/dataoecd/12/10/40922867.pdf
    Eric de La Fortelle

  • Aaron James Stupple

    Eric, That is an impressive report from OECD. I haven’t thought terribly much about the barriers- appreciate your insight!

  • http://twitter.com/AustrianSchool_ Austrian School

    “f the federal government was put in control of the Sarah Desert, in five years there would be a shortage of sand.” -Milton Friedman.  The future of medicine is an impending disaster.

  • http://twitter.com/PorterOnSurg Chris Porter

    The TED talk about portable monitoring makes me eager to hear from a cardiologist about the value of monitoring CHF biometric data in the absence of symptoms. As a surgeon, I get a lot of meaningless to confounding data from CT scans. Free air, pneumotosis, and intussusception aren’t universal surgical indications now that we frequently see high-res CT’s patients with minimal symptoms. (To say nothing of the no-symptom incidentaloma.) I never would have imagined my job would entail so much convincing of others that a patient *doesn’t* need an operation.

    Technology will take us a great distance with objective data, after which doctors will still need to correlate subjective complaints, or lack thereof. 

    Besides data collection/analysis, I suspect the professional communication model will undergo needed modernization. We still pretend doctor and patient are best served by conversations by appointment only, instead of recognizing we’re both available pretty much anywhere, pretty much all the time.

    • Aaron James Stupple

      Dr. Porter,
      Sounds like you’re talking about weeding out the noise from the signal with all the imaging? I hear you. I wonder how much of all this will be just like the computer read of the EKG, where it’s pretty good, but you really can’t trust it. 

      I like what you say about the communication bit. It’s like- why make the patient haul themselves to the office at a specific time just to exchange weightless information?

      Thanks for reading!

  • http://twitter.com/mj2smith Michael Smith

    Both personally and professionally, I say bring it on!
     This can be done today.  I think 20
    years is real safe bet, in part because as a nation we cannot afford to
    continue delivering care the way we do it now. 
    CMS has predicted that by 2015 healthcare costs will
    hit $4 TRILLION and account for 20% of the US economy.


    This is a grand change management challenge, a case
    study in the diffusion of innovation.  A challenge for People: patients, physicians,
    health care executives; Process: re-imagine health care processes; and Technology:
    The technology exists. 


    There are federal healthcare initiatives (Eric’s
    “earthquake”) already in play. 

    Reimbursement changes-Accountable
    Care Organizations-could lead the change to health care, in addition to our
    sick care system.

    Record keeping systems-The incentivized
    adoption and evolution of EMR’s-to capture, assemble, present, and share data;

    deployment of Health Information Exchange’s. 
    The HIE’s will provide connectivity, interoperability and
    standards.  Some may provide a platform for Aaron’s “central

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