After years of medical school, punishing study, and arduous training you finally sit in your office, finally a specialist surgeon. Your last patient of the day. You offer: “Having looked through your scans, I think this warrants a bowel resection, and I’m not sure keyhole surgery would be safe.” He calmly responds: “Look, I know there’s debate about the merits of keyhole versus traditional surgery, but the evidence shows that recovery is better with keyhole. That’s important to me, getting back to work. Do you offer it or not?”
Medicine isn’t changing, it has changed – leaving many of us doctors behind. And the fundamental misunderstanding of many clinicians is that the patient is now inundated with scores of irrelevant but easily accessibly information that gets in the way of good healthcare, whereas in reality the revolution has made them smarter and more engaged: and a wave of technological advances have driven this change.
The patient has moved from a blank slate to a consumer; bristling with knowledge, opinions, and information – transforming the doctor from advocate to technician.
There is a growing excitement about the potential of technology in medicine, particularly around the vast increase in data. The ability to monitor vital signs continuously, to perform high quality medical imaging with handheld devices, or to increase efficiency of the delivery of healthcare. But the real potential isn’t in the data – it’s in the connectivity. As doctors try to keep up with the growing influx of information, we miss the crux of the matter: we are no longer the bottleneck, we are no longer the gatekeeper to treatment. The patient can immediately and easily access second opinions, comprehensive evidence, national guidelines or, even more powerfully, they can form communities, they can influence medical opinion.
Even informed consent, one of the fundamentals of medicine, is being covertly taken away from our purview as doctors. In the past two years we have seen e-consent adopted for clinical trials in the UK; government officials are excited about the potential efficiency gains. Why is this perplexing for the average doctor? Because this isn’t really a question of efficiency, but a question of expertise. As the patient has become so connected and well researched the role of the doctor in consent has been minimised.
And that is just the start. Open research, the concept of sharing scientific methods, data, and results without restriction, has been proposed as a key for future healthcare innovation. It also has implications for individual patient care. Articles and data that was once only available to me, as a doctor, through an academic institution, is now readily available to the patient. This removes the layer of mystique from our clinical decision making that has shrouded medicine since its conception.
These days it is common to see forums discussing the merits of doctors and rating their service much like you would for your local restaurants, creating a marketplace where there was once a maze. And these communities extend further, subverting the mainstream medical opinion with a united and consumer-directed voice; such as the strong advocacy for Lyme disease recognition and treatment, shunned by doctors but brought into the spotlight by the shared lived experience of patients connected through the internet.
What does the future hold? The truth is my biggest fear as a doctor was my patient seeing how grey and gritty medicine really is. All that uncertainty, complexity and judgement would become public, and would be shared. But now that it is happening, it isn’t scary at all, because it heralds a new wave of medicine, truly collaborative and patient-centered, driven by individual need and desire instead of what we hand down. It’s time to make the patient an active agent, not a passive recipient.
Finally, something to look forward to…
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