My words of support to the first year medical class of 2017

To be clear, I have not been invited to speak to the first year medical class of any school. Such an opportunity is usually limited to senior physicians and professors within the medical institution. My lecture, my words of encouragement, would come across far more as a keynote delivered by Patch Adams. I personally think that such an irreverent type of welcome is important in order to get modern-day medical students accustomed to the new world, where old ideas and old ways of thinking are finally and thankfully dying off. Unfortunately, until the last professor who believes that the best way to study anatomy is to spend two years dissecting a human being has passed on to the operating room in the sky, it will be an upward battle to finally embrace the true future of medicine.

If I was standing in front of such a class of students, I would probably start off with the simple supportive statement “you are all screwed royally”. This is not meant to be a joke. The class of 2017 will finish their medical studies and residencies somewhere between 10 to 15 years in the future. This is well past the end dates of 2020 and even 2030 that are expected to be milestones in the automation and computerization of medicine.

For example, what can you possibly say to a young and vibrant first-year medical student about his or her future choice to practice pediatrics. By the time they have finished their residency and possibly their subspecialty, the greatest likelihood is that computerized assessment and monitoring will replace a great deal of what they have studied.

Determining if a child is septic and requiring of a spinal tap, one of the most delicate decisions that a pediatrician must make, will be replaced by other measuring tools that are not even invasive. A single fingertip blood sample will be enough to identify the infecting organisms that are causing the fever, and the artificially intelligent medical aide will not only suggest the most appropriate antibiotic, but also suggest dose, frequency of delivery, length of time of delivery, outpatient continued treatment, recommendations for follow-up, and ultimately simply ask the doctor to sign off on these orders.

If the doctor chooses to challenge any one of these decisions, the computer system will be more than willing to provide the literature that supports its decision. Please also recognize that choosing an antibiotic can have a great deal to do with local resistance. This means that a particular antibiotic might be effective in one community, but is far less effective in another, due to  localized bacterial resistance. Therefore, when the computer system suggests a nonstandard medication for a given patient, it may very well be due to the fact that the standard medication does not generate the expected results, due to developed resistance.

There are very few doctors who take the time to call up the infectious disease specialist and ask whether the medication they are prescribing is in fact the most appropriate, based on constantly changing degrees of bacterial resistance. Instead, the computer will automatically include this data in its decision.

Everything I have described is a superior version of care than is presently provided. The physician can definitely focus on explaining to the family all of the different events that are going on. But we must be clear that the purpose of the physician is to be nothing more than a tour guide through a medical passageway that is run by silicon. Techniques that the average pediatric resident will learn, such as taking blood from a newborn, doing a urinary catheter insertion, placing an arterial catheter into the umbilical cord vessels, monitoring the respiratory and cardiovascular status of a preemie – will all be primarily replaced by computerized systems that will respond faster and better to any situation.

Admittedly, those actions that require physical involvement, such as placing a catheter will be done by medical robots with a far higher success rate than any human being. Once again, the doctor will be able to explain the process to the family, even though the doctor is effectively totally uninvolved in the management.

The same will be true with every other specialty. Internal medicine and the management of heart disease will all be far better managed by a combination of AI and robotics. Cute smiling pint sized robot will sit on the table next to every patient, and will be constantly available to answer any questions and get help when the patient is not feeling well. Such robots will be sensitive to the emotional status of the patient and will be more than willing to listen to stories of days gone by. Patients will feel far less scared and lonely.

During rounds, the same pint-size robots will explain to the patient any of the terminology that was spoken by the medical team but was not understood by the patient. It is very likely that this small companion will even be an advocate  for the patient. If the patient is on a given treatment which is causing severe vomiting, the bedside companion may very well inform the medical team of the nausea and suggest either better antinausea medications or a change in the medical protocols.

On a microscopic level, miracles are happening every single day. Recently, it even made it to the newspapers, that there appears to be a potential cure for leukemia. One must be very careful with news like this because until it is subjected to a full and monitored study, it cannot be taken as fact. But if this solution proves to be real, and can literally eliminate cancer in otherwise terminal patients, then I believe we have experienced yet another element of the traditional expression of the time of Messiah, which is the raising of the dead.

If this technology works on other cancers, in the next 20 years, the idea of feeding poison into a patient with cancer would be considered as crude as cutting off a limb for a bad infection. The issue is that the residents who are studying during this period of time, will effectively have to learn the old system, but then immediately adopt the new system and effectively ignore everything they have been taught. Doctors are supposed to constantly update their knowledge. But we are talking about fundamentally changing the model of medical management, and this is a huge step. This will be especially difficult for students who are trying to understand what is the “right way” to treat a patient.

What happens when CT machines and MRIs are replaced by a next-generation handheld sensor that provides all of the same information. I am not talking about handheld ultrasound devices, which despite their tremendous benefit, do not replicate the quality of CT or MRI images. I am talking about a whole new type of sensor which could easily come onto the market within the next 20 years. Can you imagine a day when CT machines and MRIs will be in museums, showing how primitive our medicine used to be?

I could go on endlessly about the changes that are happening in the world of medicine that will make the lives of medical students and residents incredibly difficult. However, once the first couple of classes has made it through this transition and become comfortable with the new set of magical technologies that rewrite medical practice, it is these doctors of the future who will become the teachers and professors and decision-makers about the future of medicine and medical education. It might take 20 to 30 years until this transition has succeeded. But it will succeed. Many older professors will find a way to adapt or will go extinct [i.e. retire].

My final words to the class of 2017 would be that I envy them. I am an old man who will not see the wonders that they will. In the course of their lifetimes, they will see daily miracles that finally make medicine a practice of healing patients, rather than just postponing the inevitable. Given that the students of 2017 will very likely experience a lifespan of well over 100 years of an active life, they may very well be the ones to change the world. Once again let me say, I envy them. And I wish them the best of luck and great success in everything that they do.

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.