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It is the year 2070, and Dr Smith has just come downstairs from his bedroom at 9am to the command centre in the basement of his house. There was no visible wall here but instead his walls are all completely lined with banks of monitors and computer projections that all respond instantly to his voice commands as well as thoughts. Like generations of previous GPs who lived above their surgery in the early part of the 20th century; he too lives above his place of work. Except he does not see patients there; after all this is the year 2070 and it is unusual to see patients face-to-face in the flesh. When it does happen it is an interesting but unusual occurrence.
He is responsible for just over 6,000 patients and all their symptoms, clinical signs, thousands of daily blood tests and hundreds of images produced every 24 hours are all relayed by monitors within his patient’s bodies. Dr Smith’s patients are constantly monitored by a large number of biosensors implanted within their body, which is transmitted by radio signal to local receivers, wherever they are in the world.
This output is in turn analysed by a massive array of computers based in Iceland and the information is beamed in real time to screens in Dr Smith’s house. The vast majority of patient problems and illnesses are solved by computer-based algorithms and any medication is automatically directly dispensed to the patient (of course, the drug levels are constantly monitored by bioprobes checking for compliance and the avoidance of toxicity). Those that need an operation are directed to the nearest surgical centre where robots carry out the necessary procedures (there is no waiting list) 24 hours a day. All imaging and biopsy specimens are analysed by picture-based algorithms as there are no longer any radiologists or histopathologists; they have all been made redundant or retired. Occasionally the computer asks Dr Smith for a clinical decision but this is an uncommon event and today he checks the computer logs and all the patients have been appropriately managed and he needs to take no further action. This exercise only took 10 minutes and so since his work is over for the day, he decides to go out for a walk.
Of course, this is a fanciful tale that I have just invented but there is a serious point behind this imaginary story. We don’t need to be reminded that the NHS is struggling to keep up with the demands placed upon it. The ever rising workload from an increasingly older population with multiple morbidity being treated by an NHS that is struggling to find the funds and resources to meet the growing expectations expected of it; is a big issue for us all.
Anything that can reduce staff costs but not impair effectiveness will almost certainly be welcome to the people who have to manage the NHS budget. Healthcare is a staff intensive discipline but with modern technology and increased productivity perhaps certain tasks can be automated, taken away from humans completely or concentrated among a smaller workforce. Of course we still need the human touch, thought and decision-making but I suspect over the next few years technology will make great inroads into healthcare. Look what the internet and other associated technologies have done to the retail business (compare bricks and mortar businesses with online retail platforms such as Amazon), the banking business (online transactions) and the communications business (digital transmission of entertainment and web-based telephony).
I am sure healthcare and the NHS in particular is ripe for modern technologies to grab a major foothold and take over some of the work currently performed by humans. It would not surprise me if in years to come computers will report on scans and pathology specimens, albeit supervised by the human eye.
As far as general practice goes, I suspect in the future practices will amalgamate into much larger groups and then by their sheer size will be able to invest in highly advanced IT systems that in some cases may replace more staff. Obviously, this is pure speculation and who knows what will happen in the future, but who would have foreseen the rise of the internet and mobile phones as standard devices in our everyday lives? The smartphone generation who are currently young people will mature into an older generation who will almost certainly be accepting of this kind of futuristic technology, if and when it is available.
Although fanciful, I suspect my story at the beginning of the article may have some elements of fact in the far future. The impact on patient care could be enormous but through the ability of advanced technology, healthcare may remain affordable. However, the impact on healthcare staff’s job security, training and career prospects could become significantly affected.