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D heard a podcast recently, in which a “patient”, after going through an entire treatment procedure, realised that she had been misdiagnosed – there was no illness! This could be an isolated case, but even then, how could it happen?

Based on my recent experience with the doctor community, I realised that at least one facet of it was like any other profession. Some doctors keep themselves updated and bring a nuanced understanding. On the other hand, some still stick to what they have been told a decade or more ago, despite advances in procedures and medicines. For instance, several doctors in top hospitals for years had claimed I had a sinus problem. Dr. A finally diagnosed and treated it as a migraine, that too through a tele-consultation, and just like that those irritating headaches disappeared. In another instance, I probably became the first patient to ask for an endoscopy because the idiot gastro I consulted only because of an operational exigency, had no clue! To top that, the ‘counselling’ he did after that was practically the equivalent of asking me to take the next flight to the nearest temple town because the rest of my life would be devoid of meat, alcohol, spice and pretty much anything worth eating! Luckily, a different doctor with a slightly unorthodox approach cured me. I thankfully had my doctor-cousin J to whom I could turn to for perspectives each time I lost my mind, but not everyone has that luxury!

All of this made me think about the profession and how things have changed. In my childhood, we had trusted doctors, who knew the family and were practically friends. They asked questions, took time to diagnose and were wary of indiscriminately throwing medicine and scalpels at every problem they saw. Of course, that can be taken to the extreme too. A few years ago, my dad’s doc in Cochin was responsible for his month-long hospital stay and pretty much a downhill after, because his response to a cough for over a month was broadly ‘this too shall pass’! But barring exceptions, these days before you say hello, there are 10 tests and a hundred forms (and insurance, of course) when you have a health incident. While the earlier lot of doctors probably relied on first principles and sheer experience to train their gut and create hypotheses, which could be validated with tests, we now ironically have abstract numbers and parameters.

What has also changed is how we select doctors. References aren’t easy, so we now choose doctors much like movies and restaurants – crowdsourced reviews, notorious for being gamed, or the ‘safety’ of a hospital chain, whose revenue models are infamous. Do doctors there optimise for pleasing people or treating them? Make sure the hospital keeps getting revenue, or ensure the patient doesn’t have to visit again?

Which brings us to the nefarious component of practically everything in life now, even in a profession which was about saving lives. Money. Maybe it starts with the kind of money they have paid for their education, just as it is with a lot of other professions. They have to ensure they get return on their investments. Or maybe, as D pointed out, it isn’t even that nefarious, it is just conformity – this is what other doctors are doing. We are famous for that at a species level.^* Or resistance to new ideas – after all, it was only a century and a half ago that the doctor fraternity resisted washing hands, and the poor doctor who proposed it lost his job and died in a psychiatric institution!^**

It made me wonder about the future of healthcare – at least two aspects of it. One of the big reasons we considered Kerala for retirement is the quality of government health care. Not that it’s perfect. In a town just over 50km from Cochin, where my in-laws live, the healthcare is borderline negligent! But from the little I have read, it seems other states are worse. I don’t see this improving, PM-JAY or any other Modiware notwithstanding. The taxes we pay, which are supposed to be used for things such as this, are probably being siphoned off to shell companies or for fighting the next election.

On another front, what will the march of AI mean for all of this? Assuming we are able to program out the biases, will we have to worry less about medical costs because R&D can be potentially cheaper? Or maybe the arms race between microbes and us will become more intense. Will an increase in efficiency by the automation of tasks lead to more empathy? Will we have better diagnostics whose error rates are lower?

At the ground level, from cancer and (potential) cardiac events via eye tests or sound and more accurately, to vaccines for the pandemic, there have been a lot of advances. Getting the genome sequenced, understanding genetic risks of specific diseases, collecting data via sensors and converting them into information and insight, and even creating rule-based programs to optimise for results ranging from aesthetic to cognitive are all possible now. After we have enough data, it should be (theoretically) possible to create a rule-based AI that works with sensors connected to the body and outside, to do everything from sleep structuring (mattress, temperature control, meditation apps, timing etc) to diets (recipe suggestion to ingredient ordering and even cooking – thanks to robot chefs) to an extremely optimised version of preventive health procedures right from the time of conception! And that’s probably a personalised step 1 of immortality!

When health and healthcare change, how will the role of doctors evolve, and how (and how fast) will they adapt?

P.S. Broadly related read on education – Why we stopped making Einsteins

*Asch conformity experiments

** Keep it clean: The surprising 130-year history of handwashing