1. Medicine is a technology. Humans were the technology when the technology was mostly general reassurance, few investigations, few diagnoses, and few treatments.
2. Increasing volumes of increasingly cheap investigations and diagnoses will increasingly be sold by technology companies (who employ medical staff directly) on patient demand with minimal cost / delay to diagnosis.
3. Human medicine must reposition itself away from diagnosis to specific and specialised treatment and therapy post diagnosis.

Here is an interesting video from the TV show Maron:

We doctors used to hold all the mystique and power of medicine within us. A Patient came to us with symptoms which they expected our educated and experienced brains to interpret.

We would take a histrory and perform an examination giving us indirect clues as to what was physically going on inside the body (such as knowing the different sound blood makes as it passes through to normal and abnormal heart valves, or the effect of fluid in the lungs on the sound the chest makes when you tap it).

We would put all this together with our formal education and our years of clinical experience to come to one of a relatively few diagnoses and then institute therapies from a similarly limited (and dubious) number of treatments which only we would controll.

Then came the quickening, the march of science and technology, in the form of ever increasing tests, investigations, diagnoses and treatments.

We have become mere processing machines, decreasingly interpreting histories, examinations and instituting therapies but rather ordering from increasingly abundant tests for an even more abundant array of diagnoses which we refer to ever more specialists to instigate a host of personalised treatment plans.

This abundance is just too much for one clinician to know all of. It can sometimes be simple, but when a patient knows that a specialist probably exists just for their diagnosis, be it for counselling, physio, surgery or genomic medicine, then they want us less and they want them more.

We started dealing with huge demand by rationing referral based on scarce availability of expensive tests for diagnoses with only a few treatments. We have encouraged this in our language. GP’s talk are talked about as “gatekeepers”. The ED has become the “front door” to healthcare. We see some symptoms and then try simple cheap remedies with repeated consultations before eventually escalating if things deteriorate. We filter.

But what if the risk and cost of repeated consultations is actually more than the risk and cost of the test. What if patients get wise to the old grey guy who tells them that:

“Nine times out of ten this is nothing, I mean sure, one time you die, horribly, but I like those odds”

We can all see how the machines and technologies we have at our disposal are firmly implanted in our and our patients psyches and we will increasingly find that people don’t want opinion. They want scans or tests. They want diagnoses.

And once we test for things we only validate the initial concern.

This genie is out of the bottle and ever cheaper and more available tests mean trying to put it back in will be impossible. You see technology takes longer than we think to develop, but its effects are insanely fast and getting faster than we might ever imagine. Computer generated interpretation and suggestion of treatments are not far away. This may sound far fetched but the following is undoubtably true in the ED:

We own nothing: A computer tells us which patient to see in which order, what tests to consider, what therapy to initiate, which number to call for which specialist and what bed to put the patient in. I just sort the bits the computer can’t do. Yet.

Technology, you see, already owns the diagnostician.

Providers of these technologies should understand this and move to selling their technology as a direct consumer service as a precursor to specialist care (rather than selling hardware subsequently owned by clinicians). They can disrupt the cost in time and money to diagnosis for patients.

Medicine should move the general community to a specialist community where technology will send increasing numbers of patients for treatment.

The value in general medicine should be placed in comfort and time: to explain & counsel / review in the patients individual best interest, not in volume throughput to coded diagnostic outcomes. It should charge for time and environment in the same way as  chiropractors, hair or massage salons do and develop environments that reflect this professionalism, as these are the industries it will be competing against most when everything else is commodified.