We don’t need no education … Yes you do

I was recently having a conversation with a friend, discussing the persistent aura that doctors maintain. The most educated patients accept at face value what most doctors say. Considering, as I have discussed, that many physicians are not closely up-to-date on a variety of medical topics, such trust may be misplaced. There is no lack of medical information [of all degrees of reliability] on the Internet.  Therefore, a patient can become well-educated about their condition(s). But it seems that there still is a critical need, at least for a guide rather than an “oracle”, to lead people to the most appropriate medical decision for themselves.

This is by no means a unique situation. Last night I was watching a television program on the news, that clearly displayed how uninformed most people are about their investments, savings plans and pension programs. When presenting to a bank, an individual or a couple can easily become lost within the jargon readily used by the bank professionals. Sound familiar?

As I was watching this, I asked my [brilliant and beautiful] wife if there was a market for a personal ombudsman, who would accompany clients to every such interaction. Considering the fact that a fraction of a percentage-point difference in a loan or mortgage agreement, can end up costing unsuspecting clients tens of thousands of dollars over time, such an ombudsman could easily request a significant payment for his or her services. The problem is that many people are embarrassed to admit how little they understand about such critical financial issues. Therefore, there might not be a lot of takers for such a service.

This idea of an ombudsman has a place in medicine. I have previously discussed how the role of physicians will fundamentally change in the near future, as sensors and automated protocols take over a great deal of day-to-day healthcare. An article I was reading just yesterday on implanted versus wearable technology, definitely speaks to a near future reality where disease will be identified in the same way that your car’s sensors identify certain mechanical problems far before they manifest as a total breakdown in the car’s functioning.

It strikes me that being an informed consultant could very well be the future role of many physicians. Such a role is different than what doctors  do today. In the present day medical world, doctors are the professionals who choose what to test and make the diagnosis and then suggest treatment. In a near future reality, people will present to doctors with their status and even diagnosis already having been made by an automated system. However, at least for the next few decades, people who grew up and even retired before the modern computer age, will struggle to navigate this new type  of medical care.

Within this new reality, a doctor who is well-versed in all factors of medical care computerization, will be able to help people who are simply not comfortable with a totally automated system. The patient will present to the New Age physician and ask what the diagnosis means and if the advised treatment is appropriate. Despite the fact that these patients will have access to a computer interface that can explain everything in what ever detail they wish [and in whatever language they wish], there will still be many millions of people who will desire a human face on their computerized medical care.

For a physician to be effective within this reality, he or she will need to spend the majority of their time reading and staying up-to-date with the latest and greatest medical innovations. I personally read hours every day, in order to be an effective consultant. But even I struggle to keep abreast of the many advances in medicine and medical technology. Today’s doctors, whether their claims are reasonable or not, have little time to stay up-to-date. However, once these physicians no longer have to deal with the basic process of examination, testing and diagnosis, they will either morph into this new form of medical consultant or be left behind.

Medical schools, of course, will need to alter their curricula to reflect this change. Doctors will still need to learn anatomy and physiology and they will need to learn the process that starts with taking a history and ends with making a diagnosis and offering treatment. But these new doctors will have to be taught how to work within teams of varying specialists, interact with all of the latest technologies and finally and perhaps most importantly, learn how to transmit information to patients in a professional and empathetic way.

As a point of interest, it might be that within this new reality, surgeons will be encapsulated into a very specific type of service provider. It will not be the surgeons’ responsibility to admit the patient, do daily rounds and follow-up the patient after discharge. A physician may very well “order” an appendectomy just as he or she would order a blood test today. The surgeon would effectively meet the patient for the first time in the operating theater, and go home at the end of the day, leaving all continuing care to others. There are many surgeons who would actually be very happy with such an arrangement. They could focus entirely on their  specific skill set, and still have a personal life.

Even today, he who has the knowledge has the power. Doctors will lose some of their status and power. They will not be the only ones with the keys to the kingdom. Doctors will transform from being purveyors of information [as they are today] to being a go-between from the digitalized medical world to the patient.

Here is an interesting thought: will the definition of a physician be that person who prescribes treatment. If so, doctors may retain the role of being the final arbiter between existing medical knowledge and its application to patient care. Even though computers will tell the physicians what to prescribe, at least for the next few decades, it will still be left to a physician to write the order for a medication, a procedure or for an invasive treatment like surgery.

If that will be the case, then the medical ombudsman will not need to be an MD. This will be an opportunity for a wide variety of people to study medicine  but focus on human interaction, even as computers run the whole show.

I am of course guessing about this entire issue. I have no idea how things will change and what roles physicians will play once computers really can make reliable diagnoses. I would say though, that a far greater number of people should be discussing such issues and making plans for the new reality. If the medical schools wait as long as possible until they are forced  to make changes in their curricula as a reaction to changes in the real world, such schools will always be perceived as being behind the times. And I suspect that such schools will slowly lose an audience. This natural selection will preserve only those schools and other forms of training programs that have adapted.

I hope that all of the appropriate professionals will embrace the inevitability of this new medical world order. If not, there will be unnecessary confusion and delays in healthcare. But for those patients who can understand on their own, without an ombudsman, their own medical care, such patients will benefit far earlier and far better from all of the new and improved services that are coming down the road.

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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