Doctors need to be part of the digital revolution

There’s a big discussion going on in the health tech community about a controversial keynote speech given by Vinod Khosla at the Health Innovation Summit (HIS), in which he stated that 80% of what doctors do could be replaced by machines.

If you’re a doc like me who has no idea who the heck Vinod Khosla is (he’s a venture capitalist and co-founder of Sun Microsystems), why he’d be a keynote speaker at a healthcare event and what the heck HIS is, well, that’s the point of this post.

You see, there are a whole lot of folks like Khosla out there – investors, entrepreneurs, tech types – who are attempting to redefine healthcare according to their own personal vision.  Where we see a healthcare system in crisis, they see opportunity – just another problem with a technological solution.  Computer-driven algorithms are the answer to misdiagnosis and medical error, iPhone apps can replace physician visits, video connectivity can increase access.

Where we see illness and distress, they see a market.

And what business folks like to call disruption in the marketplace. Think about what happened to downtown small town USA after the first shopping mall opened. Or what happened to movie houses when Netflix started offering DVD rentals online. Or where all the independent bookstores went when the first Borders opened up, and what happened to Borders when the Kindle hit the market.

Out with the old, in with the new.

If Khosla is right, the we docs in our offices and hospitals are the old downtown department stores, the bookstores and the bricks and mortar businesses in an online revolution.

We’re replaceable. At least most of us.

Is Khosla right?


The therapeutic relationship between a doctor and a patient can never be replicated by an iPhone app. Not when so many of my patients leave my office on a daily basis telling me how much better they feel just having spoken to me. It’s a powerful and sacred relationship that is irreplaceable.

These days, however, almost all of my patients have Googled their symptoms, and many have done a over the counter diagnostic test or treatment  before coming in to see me. I’ll never see the ones who got their questions answered online or their symptoms cured by that over the counter med – I see what’s left after self-diagnosis and self-treatment has failed, or Google told them to see me.

That’s disruption, isn’t it?

One day very soon, women will be able to screen themselves for cervical cancer and STDs using a self-administered vaginal swab. No need to see me unless the test is abnormal, or there are symptoms.


Of course, computer driven diagnostic algorithms, apps and programs can create a whole new set of problems in over-diagnosis, since “there’s nothing seriously wrong with you” is rarely an output.  In my office, that’s a very frequent clinical assessment. Functional ovarian pain.  The occasional errant menstrual cycle or missed period. Anxiety. Stress. Depression. Lack of sleep. Over-eating, over-drinking, over-medicating.  What computer is going to pick that up?

Not to mention trauma care, surgery, childbirth, respiratory distress and any one of thousands of health emergencies that you can’t treat with an iPad.  I don’t see any of that work going away for docs anytime soon, do you? Some of it, of course, is being shared with trained non-physicians, and even robots. But docs are still an indispensable part of the healthcare mix.

So while the mix is changing, we docs are still in it. And I don’t see that changing. At least for here and for now. But the future?

I don’t know.

Doctors need to be part of the digital revolution

I do know that if this is the new revolution in healthcare, we docs better get in on it.

Take the EMR as an example of what happens when docs let non-docs innovate in healthcare without significant physician input. We become typists, not physicians. Clerical work that used to be done by lower paid staff – entering lab and radiology orders – becomes ours to do. We spend the majority of a patient visit looking at a computer screen and not the patient. Retrieving relevant clinical information is like searching for a needle in the haystack of required fields of entry, most of which are not necessary to provide care.

Indeed, we have not yet shown definitively that EMR’s improve outcomes.

And yet we’re all using them, aren’t we?

If we are not part of the digital revolution and leave it to the venture capitalists and entrepreneurs, they will develop products that may sell, but if they don’t improve outcomes, all that will have been accomplished is a disruption in a marketplace.

Wouldn’t it be so much better if we could disrupt disease?

The real opportunity in healthcare innovation

There are millions upon millions of folks – some in American, but most in the undeveloped world – who have never had, and will never have the opportunity for a patient-physician therapeutic relationship such as that I’ve described above. They have no one to call when Google tells them to “talk to your doctor”.

But the overwhelming majority of the do have cell phones. Amazing, really. We can’t get indoor plumbing modern contraception or malaria tents to those in need, but 80% of folks in the developing word have cellphones. If that’s not an opportunity and a potential market for healthcare innovation, then nothing is. If we can get any healthcare into the hands of these folks, even if it’s healthcare delivered by a mobile app, we have the potential to improve their lives.

Now, imagine that we docs were able to free ourselves from the 80% of our work that can be replaced by technology, and then redistributed ourselves (virtually and personally) across the globe where we were truly needed, so that we could provide needed healthcare to the entire planet?

Now that’s disruption.

Margaret Polaneczky is an obstetrician-gynecologist who blogs at The Blog That Ate Manhattan.

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  • Robert B Walker MD

    Couldn’t agree more and very timely in that I flew into NYC last night to speak at a conference: “Living by Numbers: Wired Health Conference Explores Personalized Medicine” Medicine is like Japan prior to the turn of the century. Isolated and probably would have stayed that way without external pressures. Health has that same culture. How cool would it be if the people and ideas of the Wired community and LifeHacker team with IHI and the rest of the medical community? We in medicine need be part of the conversation for sure, but we have to be willing to let go of some of our traditional ways in order to do so. Decreasing our physical footprint and increasing our virtual one is a good litmus test as we move forward. We need to start thinking more like software developers so we can scale and sustain Health with the game changer on everyone’s hip: the smartphone (hopefully soon to be the “genius phone). A GPS for life.

  • Izzy

    We cannot clearly ascertain the success of technology when it comes to improving people’s lives. New technologies are embraced because they are novel, convenient, they are the its and ins of the moment. But they do not necessarily enhance our lives. Take for example social media. It redefines social interaction by making everything available online. What we lose however is the important relationship that can only be cultivated through personal contact. Technology isn’t always rainbows and unicorns. If I hand two kids a piece of writing board each and leave them in a room for 20 minutes, will they write on those boards or hit each other with it? Likewise, online medical apps that promote self-diagnosis doesn’t always help the patient. Technology cannot replace what doctors do, it just shifts it to a different alley with a cool factor to it. People and technology are evolving and that’s great, but through this evolution, it is important to hang on to the traditional–the real patient care that only doctors can offer.

  • Eddie Davis

    What doctors “need” to do is take control of healthcare and stop reacting to what others tell doctors they “need” to do. Technologies provide us a set of tools which can be used to improve processes when those tools are appropriate, effective and designed by those who understand their use.
    I would be a bit hard pressed to design a tool for an auto mechanic but if asked to do so the first thing I would do is talk to as many mechanics as I could to see what they need to make their job better.
    Physicians need to stop reacting and start taking the lead on such issues. Those practicing “in the trenches” are very busy and have little time to be activists. Unfortunately, ceding decision making in healthcare to those outside parties seeking to control healthcare will only allow the siutation to worsen.

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