The medicine model has changed since our predecessors practiced medicine in the days of Dr. William Osler. These days, medicine is a commercialized industry. The hospital makes this clear by prioritizing charting and patient satisfaction over patient care. Also, patients are accountable for making it feel this way. Some patients want to dictate their care completely, like making an order at Burger King. Physicians are encouraged to please patients, because three stars are better than four under their name on Google. This is only the beginning.
In the future, medicine will likely go something like this: imagine a world where only three big companies essentially run everything. These companies are Facebook, Amazon, and Google. After breaking into the grocery shopping industry, Amazon decides, why not medicine?
Future customers, I mean patients, will all have a medical profile. Their genome will be uploaded, and known health risks will be displayed. Genetic specific advertisements will pop up frequently while one tries to click through to their first appointment with a “physician,” really an artificially intelligent being “trained” in medicine. This bot will analyze genetic and lifestyle risks and make suggestions. It will also recommend vaccines and screening. Patients can then go to a local Amazon clinic and get their vaccines and screening tests by assembly line nurses and doctors; until AI can do an IV and colonoscopy.
If patients are sick, they’ll type in symptoms and the on call Dr. Bot will run an algorithm of the likely causes.There will be handheld scanning devices developed by Google that patients will use to upload imaging. Patients can then go to a local Amazon, have their blood drawn and treatment given. A significant fewer amount of doctors and nurses will be involved in these clinics. Since hospital stays are costly, Amazon finds a way to reduce this. Only those who require ICU and step down care will be in the hospital. The bots will analyze mortality and reduce ICU time based on this data. This may include ending care. If Donald Trump can be president, anything at this point is possible, right? Meanwhile, all other care will take place at home or Amazon hospital homes. Again, this will mostly be staffed by Dr. Bots, cheap residents and nurse practitioners. There will be a significant reduction in the need for human physicians. Who knows what the implications on morbidity and mortality will be.
The doctor-patient relationship will not really exist. It is already being reduced with hospitalist medicine, high volume and high turn over. Internal medicine docs are scarce and can only spend so much time with patients. With no major incentives to go into internal medicine, this will get worse. More young docs with colossal debt will opt to specialize.
As a training physician, I am not very optimistic about this inevitable transition. Job security will reduce, along with the doctor-patient relationship, and the art of medicine. Since I envision this change, I’m working on plan B like most other people in my generation. I hope this new model will be a bust and we return to old school medicine. Until then, I will need a side hustle. I’ll also need to create a specific niche to compete in this new world.
