Nahum Kovalski

Is there a Doctor … anywhere ?

I recently read an editorial in the NY Times about “Bottlenecks in Training Doctors“. The focus of the article was about the severe shortage in physicians in the US. More so, the article spoke of the expected worsening in the shortage of physicians as years go by. This is hardly the first article I have read about this issue, and I am sure it will not be the last. My issue with the article is that it does not consider, as a possible major solution, the use of IT.

Henry Ford is quoted as saying ““If I had asked people what they wanted, they would have said faster horses”. The significance of this statement is that people tend to think of problems and their solutions, in terms of present day available options. Before the iPhone was released, no one predicted that smartphones would become THE means by which the Internet was brought to so many people, especially in the developing world. The low power consumption of phones and their ability to present full online experiences in a mobile fashion meant that desktop computers could effectively be replaced for many users, especially in the developing world.

So, when asking doctors of today as to the solution for low doctor availability, it is not surprising that the answer is “make more doctors”. Training a physician is expensive. It is also very time consuming and demands a great deal of resources from the community. If you read various blogs and op-ed pieces on physician remuneration, there are endless complaints about how physician-care has become commoditized and how doctors are incapable of paying back their hefty school loans. Doctors also consistently comment on how the rush to see more and more patients has destroyed the doctor-patient relationship. So, it seems that in the near future, the solution will not be simply finding more doctors.

Technology must be embraced to turn doctors into digital hubs of healthcare. I am not speaking (yet) of implanting chips into doctors’ brains and hooking them up to supercomputers. What I am speaking of is using doctors as overseers and managers of other (less expensive and more quickly trained) health professionals who would be the “soldiers in the field”. I want to be clear that this is NOT only a solution for the developing world. If doctors have been turned into a commodity, then the way to deal with this is to find ways to add value to doctors and make them more unique and powerful generators of better healthcare and, yes, money.

So, imagine a group of physicians manning a set of terminals, very much like air traffic controllers. These physicians would be in constant contact with a large group of non-physician health care providers spread over various geographical areas. Using remote presence, the physicians would know a tremendous amount about each patient, perhaps even before the patient is first seen. Computerized alerts would draw the physicians’ attention to critical cases that must be dealt with immediately. Wearable technology used by the field-based providers would be their lifeline to the remote physicians. From the patients’ point of view, they would experience a calm, professional and knowledgeable health care provider.

In the hub with the physicians, there would be communication tools to contact specialists as needed. With a click of a button, a cardiologist could be contacted to review the case and the messaged ECG. When the cardiologist responds, this information would be passed back to the field. All of this interaction would be documented and reviewed later for performance analysis (to improve output and speed communications). In this same hub, the physicians would have direct access to the top level artificial intelligence tools that constantly assess the patients and provide suggestions for further testing, likely diagnoses and appropriate treatments.

The argument that patients want to see a doctor is based on the assumption that a doctor is privy to a unique knowledge and skill set. In the scenario described above, this knowledge will be fully available but more so, will be made available to far more patients in a given time frame. This approach could allow expert physicians to draw much larger salaries while still reducing overall healthcare costs.

It is not so jokingly said that the bottom half of a medical school class is still called “doctor”. In this new environment, only top level physicians would survive. Medical schools would adapt to select physicians based on their ability to quickly process information and to multitask. Physicians would be trained in management of people as well as of disease. I would even venture to say that the standards for being accepted to medical school would be significantly raised and that the number of physicians graduating would not increase. The intent would be to generate  top tier professionals across the board. As in select army units, those that fail to keep up even after being accepted would leave. When all is said and done, physicians would truly no longer be commodities. This would be to the betterment of the physicians and the patients who benefit from their input.

All professions will have to adapt as time goes by, due to advances in technology. In the case of medical care, the demands of a public that is living longer and suffering a significant disease load, will create the need for innovative solutions that are not based solely on more graduating MDs. This will be a difficult adjustment for those in the healthcare community. But it is an adjustment that must happen.

I want to finish this blog post with another link to a NY Times article called The future of robot caregivers. This opinion piece is beautifully written and truly sums up the issues at hand with robots replacing humans for day to day caregiving for those in need. The last 3 paragraphs of this article describe a scenario that sounds eery but is in fact full of hope. For those who would resist the development of human-like robots (that do not have any suggestion of a consciousness), I beg them to read this article. We need these technologies. It really is that simple.

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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