By Professor Hooi Shing Chuan, Department of Physiology,

Dr Dujeepa Samarasekera, Centre for Medical Education &

Dr Terry Pan, Department of Anaesthesia

Imagine, the year is 2050. It is 6.50am, a routine Monday morning. You are about to go to work after a sumptuous breakfast prepared by your new automated cooking robot – Moley (hyperlink: http://www.moley.com). Suddenly the Organo-wrist (ORIST), a watch you have been wearing which monitors the organ systems, detects a sudden increase in heart rate and drop in blood pressure.


Within seconds, Dr Fam, your family doctor, appears before you in the form of a hologram. “Mr Pan, body sensors and house cameras have picked up an acute swelling of your eyes and wheezing in your breathing. It is likely that you are having an anaphylactic attack. Please stay calm. EMRRO will be there very soon.”


Dr Fam’s immediate “presence” and reassurance brings a much-appreciated calm to a tense situation. EMRRO (Emergency Response Robot) is the latest emergency treatment robot acquired by the city’s healthcare system, which has moved most tertiary care from hospitals into patients’ homes. EMRRO, touted for its reliable and precise care, arrives just as Dr Fam finishes his sentence. EMRRO delivers a new personalised anti-anaphylactic drug, matched to your DNA profile, through a nasal spray, and brings your vitals back to normal levels within minutes. Throughout the treatment episode, EMRRO monitors your vital signs and patiently responds to all your questions.

 

All around the island, hundreds of medical emergencies are being monitored in real time by attending On-Call Physicians like Dr Fam. EMRROs are sent to homes to deliver appropriate care where necessary. Patients are remotely monitored and direct communication maintained with a medical professional throughout the care management.


As you recover, Dr Fam advises you to keep ORIST strapped on as your genetic testing had revealed increased propensity for atopy. You feel thankful that you had taken Dr Fam’s advice.


COULD THIS BE THE FUTURE?
We live in an ever shrinking and increasingly inter-connected world linked through technology. Advances in medicine, genetics, technology, robotics, big data analytics, machine / deep learning will radically transform and disrupt the practice of medicine. What does the future hold? How do we think about the future? Richard Smith, writing in the British Medical Journal, posits: “Extrapolation of current trends is a poor way to think about the future, particularly at times of great change.” We are in a time of great change. We cannot think about the future in small incremental steps, we leap into the future by our imagination. So let’s imagine…

 

IMAGINE A FUTURE WHERE SUPERCOMPUTERS ARE BETTER DIAGNOSTICIANS THAN HUMANS

Already, cognitive computing, like the IBM Watson project, is training computers to learn and decipher unstructured data. Ever since it bested the two top trivia champions of Jeopardy! in 2011, Watson has been kept busy with the ins and outs of the healthcare industry. It is already providing insights into optimisation of possible cancer treatments to oncologists at the Memorial Sloan-Kettering Cancer Centre (MSKCC) in New York City. The real benefit of using cognitive computing like Watson is that it may be trained to help oncologists in the community who see a handful of patients a year achieve the “same level of expertise” as oncologists at MSKCC, who see thousands of such patients a year (Miller, 2013). Watson is also able to provide the latest research at a click of a button to anyone connected to it. In addition, with cognitive computing being able to decipher unstructured data such as natural speech, Watson, may actually “see patients as individuals and not a number on a page” (Miller, 2013). In the face of such disruptive challenge, what then is the role of the human healthcare provider?

 

IMAGINE A WORLD OF PERSONALISED MEDICINE
The entire human genome can now be fully sequenced in a short period of time at relatively low cost. This cost will continue to go down as technology advances. In 2012, the national UK 100,000 Genome Project “created excitement and hope that by sequencing thousands of Britons, more clues about cancer and rare diseases would be identified” (Haga, 2017). Coupled with a deeper understanding of the basic mechanisms of disease, as well as the deciphering of the epigenetic code and advances in small molecule design and synthesis, personalised medicine for most diseases will become a reality. This will minimise side effects and reduce overall costs for the patient. Counselling patients, empowering them to decide on the best treatment options for themselves (whether for maintenance of health or therapy), will be an even more important skill for doctors in the future. Actress Angelina Jolie made headlines in 2013 by opting for a “preventive” double mastectomy after being found to have the BRCA-1 gene, a genetic marker that confers carriers with a 65% risk of breast cancer and 39% risk of ovarian cancer. Genetics provide additional information for more informed decisions about personal health and, in Angelina Jolie’s case, changed her future.

IMAGINE A WORLD WITHOUT HOSPITALS
Nobody likes to stay in hospitals. We want to be cared for at home, with family close by. Patients will be increasingly empowered to learn about themselves so they can take care of themselves in the most comfortable and supported environment – at home. Advances in robotics, home monitoring, telemedicine and communications will be integrated to make this a reality. With the advent of wearable technology and improvement in health monitoring, doctors will be better able to acquire health data from a patient’s smartphone, reducing the need to see the doctor at a clinic. The current trend of increasingly minimally invasive surgery, coupled with the use of precision robotics, suggests that future surgeries will be less intrusive and more automated. Future surgeries may be painless and preclude the need for anaesthetics, achievable with the use of ingestible microbots that can perform surgery from inside the body.
Delivering more humane, integrated, cost effective and safer care without hospitals, or at least hospitals as we know them now, will be a reality. “Primary” healthcare will be the new “Tertiary” care.


CONCLUSION
Although technology and science will radically transform the practice of medicine in the future, what will remain unchanged, at the heart of it all, is the doctor-patient relationship. When we are sick and most vulnerable, human beings will still prefer to engage and “trust” a fellow human being over a robot. The communion of kindred souls and the care of a fellow human being bring healing beyond medicines and surgeries. Values such as professionalism, empathy and trust transcend time and technology. In fact, the more pervasive the technology, the more important it is to uphold these values in the doctor-patient relationship.
In view of impending disruptions to clinical practice, how should we imagine medical education and medical schools? Technology is a great knowledge leveler. Doctors and healthcare workers will not need to memorise all the evergreen medical facts and theoretical information, since factual information would be readily available anytime, any place, instantaneously. How then should we teach and prepare our students for future practice? Can we reimagine medical schools?

References

1. Smith R. The future of healthcare systems. BMJ. 1997;314:1495-1496.


2. Miller A. The future of health care could be elementary. CMAJ. 2013;185:E367-368.


3. Haga SB. Update: looking beyond the 100,000 Genome Project. Per Med. 2017;14:85-87.


4. Lambert, V. Inside the hospital of the future. The Telegraph. December 12, 2016. http://www.telegraph.co.uk/wellbeing/future-health/hospitals-of-the-future/


5. What Will Medicine Look Like in the Future? https://youtu.be/NkufJj3FVt0. Updated June 27, 2016. Accessed February 27, 2017.


6. Goodbye TAs: Georgia Tech Professor Reveals Online Assistant“Jill Watson” Was a Robot https://mishtalk.com/2016/05/16/teachers-assistants/
Accessed February 27, 2017.