Dr Keith Ison OBE
This article is a synopsis of a lecture to members of the London School of Paediatrics on 11th July 2017
Technology is improving and changing at an ever-faster rate – and this rate of change is going to continue accelerating for the foreseeable future. Technology is moving from the experimental stage to clinical practice and to the consumer faster than ever before. In our everyday lives, the relentless pace of development of mobile phones, smartphones and computing technology is a demonstration of this.
The cost of genome sequencing is a good illustration of the absolutely phenomenal pace of change. The first complete human genome sequence in 1999-2000 cost almost $1 billion; within a decade this cost had dropped to below $50,000, and this year the cost is only a few hundred dollars. Genome sequencing is only going to get cheaper from here on in – and the cheaper it gets, the more everyday applications it will have.
White line: Moore’s Law / Green line: actual drop in cost of genome sequencing
‘Moore’s Law’ is a computing term which came from a 1965 paper by Gordon Moore – he saw that that the processing power for computers had doubled every two years and predicted that it would continue to do so. This continues to more or less be the case in computing – but in complex areas like healthcare this doesn’t capture the synergistic effect of developments in different areas, new tools and technologies, better knowledge sharing and increased competition and collaboration across the world.
Recently we have seen an explosion in the use of new technologies in clinical practice: telemedicine, robot-assisted surgery, automated image analysis, rapid PCR testing, 3D printing and more. This process is likely to accelerate.
Technology for respiratory virus identification is advancing exponentially
The next twenty years will see a period of rapid discoveries in areas like genomics and cancer. Diagnostic tools (including multiparametric monitoring and imaging) will become more precise and more informative. Our ability to link facts together to understand the range of ‘normal’ functioning, causes of disease and possible interventions will be boosted by developments in artificial intelligence and the capacity to process vast amounts of data.
New tools and technologies in healthcare are exciting, but they also bring along new clinical challenges and ethical dilemmas. These are going to stir up political and moral debates – including whether we allow gene editing to correct genetic defects, prevent disease or augment ‘normal’ function. Will these and other future developments in healthcare benefit the few, or actually reduce health inequalities for the many?
In the world of professional work, artificial intelligence and expert systems are going to change the roles of all groups, including those in medicine. Experts will support staff who are less qualified and experienced to deliver healthcare, making selective interventions and creating expert systems to support diagnosis, treatment and patient management. Patients will increasingly demand the best quality of care, and all but the most urgent interventions will be planned in advance (e.g. with virtual surgery or 3D modelling) to reduce morbidity and increase safety.
Some broad ideas to help doctors through their future careers in this rapidly changing environment include:
Always keep abreast of what is coming down the line. Seek to understand the future impact of science and technology – its content, context and ethics. This won’t be trivial as things are going to be moving fast. Having the ability to recognise what is going to be important before it happens will be an advantage, so ‘horizon scanning’ in diverse areas will become more essential.
A switch of focus to look more at underlying causes than patient symptoms. The next 20 years or so will be about uncovering why things are as they are and discovering what can be done to improve overall patient health, within individual and contextual limits.
Always question the quality of evidence and any deductions made from it – whether the information comes from human or machine.
Work in teams to look for new approaches and involve patients – more diverse teams usually get better results.
Standardise on best practice. It may be difficult to find and agree on, but only when things are standardised can incremental changes and improvements be made in a planned way.
Repeated near misses are a sign of system failure. Don’t waste time trying to keep broken things going but engage with the system to solve the underlying problem, whatever that may be.
Prepare for radical changes in roles and in future teaching and training.
Work across disciplines, and think about whole systems. Keep an eye out for the Royal Academy of Engineering report due out on systems thinking in healthcare.
Finally, there is a lot to be optimistic about, much to explore and much to look forward to. The generation of doctors now in training has an unprecedented opportunity to embrace change and lead transition to new models of healthcare and to be involved in the creation of a new, more advanced and more responsive healthcare system which has enormous potential to benefit patients individually and the population at large.
Dr Keith Ison OBE, MA, MSc, MBA, PhD, FIPEM, CSci
Keith studied physics and material science at the University of Cambridge before training in medical physics in Hull. He completed a PhD in biomaterials in Bath, then worked in London in various NHS scientific roles. He was head of medical physics at Guy’s and St Thomas’ Hospital from 2001-17. He is a past president of the Institute of Physics and Engineering in Medicine and was awarded an OBE for leadership and development in healthcare sciences in 2012. Now retired, he continues to speak on science and technology in healthcare to a variety of audiences.
The website http://medicalfuturist.com/ (the work of Dr Bertalan Mesko) – a frequently updated site that covers a whole range of science and technology subjects in medicine.
Some books which may be of interest are:
The Patient Will See You Now: The Future of Medicine is in Your Hands, and The Creative destruction of medicine – both by Eric Topol address how the relationship of doctors and patients is changing fundamentally and how technology is impacting on how patients and doctors approach healthcare and each other
The Future of the Professions: How Technology Will Transform the Work of Human Experts by Richard Susskind and Daniel Susskind – A fascinating look at how technology and the information revolution will change society’s relationship with experts in all fields
Homo Deus by Yuval Noah Harari – tackles the question of where humanity is going in the coming decades and raises some challenging questions, “In an unequal society the rich may hijack the research and healthcare agenda to upgrade themselves and their children. How might we face up to this?”. These sort of ‘science fiction’ topics are likely to be real ethical issues in our lifetime.
Surviving AI by Calum Chace, gives an introduction to AI and the challenges and opportunities that it will present in the future.