Doctors as gatekeepers

Recently I´ve grown interested in the whole Quantified Self thing. It has many other names,  but the core meaning is clear: We, humans, are beginning to have better and better ways to measure ourselves. [1] This capability increases along 3 axes:

  1. Measuring ourselves is getting cheaper (e.g. measure your heart rate with a phone App)
  2. We can measure much more stuff (e.g. heart rate, physical activity or blood sugar levels were just the beginning, now we can get readings on hemoglobin saturation, ECG, HRV and PWTT all in 10 seconds, with a single device)
  3. We can measure our bodies with increasing precision at levels that used to be reserved for scientists, astronauts or doctors.

More on this later on. [2]

Traditionally speaking, doctors help people by identifying causes for problems and, based on their extensive (and expensive, but more on that later) knowledge, suggest strategies and treatments. While a lot of symptoms require nothing more than a visit to a doctor to be detected and/or identified, others need some more advanced diagnostic procedures and tools. But these are getting easier to get a hold of.

For sake of argument, lets say that we can get all the tests we need ourselves. It could be still far away, but that capacity is on the horizon. In that scenario, we could know everything a doctor needs to know to make a diagnosis and prescribe a treatment.

How does this affect our relationship with our Doctors? We could give them all the information without having to ask them for the tests. We could get that information much faster and probably easier and cheaper too. Clearly this empowers us as patients.

Now let’s take an extra step. We measure ourselves, get the needed data and use that data to understand what is wrong with us and what we can do about it. This is something we already do with technology, googling for problems with our software and devices and proceeding to fix them. It is not such a huge step to fix ourselves too. We already do this for minor afflictions, and as medicine progresses and big health problems of the past become mere nuisances, it is inevitable that we extend the self-treatment approach to things that seem scary today.

What happens to Doctors then? Besides the important and necessary social aspects of the profession, its technical side would have been somehow commoditized.

The first impact that I can think of is a shift of Medical Practice from diagnosis and application of treatment to supply of authorized treatment. 3 In effect, this renders Doctors as gatekeepers, standing between the patient and the solution she knows is appropriate.[3]

It is not hard to envision that people will see Doctors in a different way. Perhaps in a less mystical way. [4]

Is this a good thing? Will Doctors face the same sort of stresses Teachers are facing with the expanding access to knowledge and its increasingly shorter shelf life? What we will replace that social role with? Will the profession lose some of its allure to high achieving students looking for lifelong passion? Will we be able to train doctors easier, faster and cheaper? Will there be more or less Doctors?

I have no answer for these questions, but they will be answered by all of us in a not so distant future.

[1] This is not exactly new, BodyMedia, has been researching into this at least as far as 1998. Interestingly enough, they are often not the most recognizable player.

[2] The reasons for this advance are many and worth a second post, but availability of smaller, cheaper sensors, Lab-on-a-chip stuff, triangulation of data via other sources and advances in data processing are all part of it. Definitely pay attention to this, because there  is a clear interplay of trends at work here.

[3] Im assuming that we are still too far away from completely open access to any treatment without professional validation. It can happen, but is a trickier issue at this point.

[4] The craft of healing, whatever the methods, seems to have always been surrounded with a deep sense of reverence and respect. From village healers to world renowned surgeons, we have a special place for those who fix us. Either physically, spiritually and mentally.

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