I had an interesting conversation at the 2015 MedX conference with Eric Topol, MD, one of the luminaries of digital health and the author of the book, The Patient Will See You Now: The Future of Medicine is in Your Hands.
We talked about democratizing medicine, a topic he had just spoken on as the opening Keynote of the conference. I asked him what he meant by the term “democratizing medicine.” Here is what he said:
“The term refers to having medicine available to all. That has many different layers. The most important one is getting rid of the information asymmetry and changing the control levers so that each person, with the new tools that we have today, takes charge and ownership of their data and ownership of their health.”
Everything in medicine needs to be flipped
Eric went on to say that everything in medicine needs to be flipped. It’s your civil right to have your medical data and yet in 49 states (all except New Hampshire), data are legally owned by doctors and/or hospitals.
“That has to get fixed. We can’t democratize medicine [until we fix that]. It should be [patients’] entitlement…not just access to information, that is not enough…[patients] need to own it and grant rights to sharing it with doctors and hospitals. that needs to be flipped. Everything in medicine needs a great inversion.”
He went on to say that it is inevitable that this will happen because the digitization of information makes it possible.
From paternalism to partner
Eric and I trained in the days when doctors owned the knowledge and the data. We even thought we owned the patient. In fact, we thought we owned everything. We even set up a system where the patient had to come to us instead of the other way around.
A lot of that has changed (thank heavens), but there is still a long way to go. I asked Eric what he thought medicine would look like after we are successful at putting into place the changes he talked about. He said,
“It’s going to take a while….Like everything else in medicine, it will take longer than it should. And, it’s not going to happen from within the medical community. That’s like asking the stagecoach drivers to build the railways.”
He speculated that it could be a consumer-led movement that leads to the change and I fully agree. In fact, I would add that we are already seeing empowered patients driving many of these changes ranging from Dave deBronkart’s demand “gimme my damn data” to patients just doing it themselves. Eric also suggested that large employers may use their purchasing power to drive the system towards this new way of doing healthcare.
Do-it-yourself? Or do-it-together?
I wondered if Eric could envision a time when we will go from democratizing medicine to do-it-yourself (DIY). He said,
“The tools of being able to do your own diagnosis and monitoring where you then go to the doctor and say here’s my data what do you think. And the doctor not only has oversight, but gives you wisdom, guidance and counsel. That’s where we are headed. So it is not truly DIY, but part of it is doctorless.”
He continued, saying that patients will have tools to acquire data (for example, lab tests, physical exam components, sensors) and they will have machine-learning in the context of the real world to interpret the data. But, he said, “You still need treatment, you still need oversight and you need the human to human factor that is so essential.”
What about the medical profession?
All of this is going to require the medical profession itself to adapt in significant ways ranging from how we pick who gets into medical school to the way we train young doctors. From the doctor point of view, I asked, “What’s going to happen to the profession?” He answered,
“Doctors at this moment in time may be considered to be at the ‘peak of disillusionment’. And, so I think this is actually a very formidable improvement because it decompresses the workload and shifts a lot of responsibility and charge to patients. So, if we are willing to embrace this change, it could be our best way out. Because otherwise we are saddled with a ridiculous amount of responsibilities that really should be handed off. Patients and their families can take a lot more charge and they want that if we let them have it.”
He cautioned that this could take quite a while because there is a lot of resistance to these changes.