By Chet Yarbrough
Written by: Eric Topol
Narration by: Eric Michael Summerer
As is inferred by the title “The Patient Will See You Now”, Doctor Eric Topol foresees a substantive change in doctor/patient relationship in America. The change is partly foreseen as a consequence of technology but more fundamentally the change is a realization that doctors are service providers; not oracles or patriarchs.
Topol suggests relationship between doctor and patient became codified and rigidified by Hippocrates. In the Hippocratic Oath, the mantra of medical practice became secretive and patriarchal.
Hippocrates writes “I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.” The personal pronouns “I” and “my” exemplify Topol’s criticism. The table for western medicine is set by the Hippocratic Oath. Physicians make decisions for their patients based on a doctor’s inferred ability and judgment. The patient is irrelevant except as it relates to the doctor’s perception of the patient’s symptoms.
In the modern age, Topol argues that the internet and technology are leveling the relationship between doctor and patient. Topol suggests doctors who wish to improve their medical performance should encourage patient participation in the diagnostic and treatment process. Topol argues that patient enlistment will improve medical treatment and reduce medical costs. He argues medical treatment will improve because patients are less likely to be entirely forthcoming when talking to a “father”. But, when talking to an adult, as an adult, patriarchal reticence is mitigated. Medical costs, by Topol’s reckoning, are reduced because leveling between doctor and patient leads to better diagnosis and less potential for errant costs of ineffective treatment. Topol also notes that technological advances in patient’ diagnostic devices will reduce costs by allowing patients to test themselves.
Topol arrives at his conclusions about doctor/patient relationship by identifying technological potential of computerized medical records, data base availability, and algorithmic medical diagnosis. Judging from other doctors like Don Berwick, Barry Bittman, Thomas Goetz, and Atul Gawande, Topol is on to something.
Berwick argues for patient centered care.
Bittman reflects on the future of US healthcare, its rising financial burden, faltering medical treatment, and need for broad medical network cooperation.
Topol identifies technological advances that transform relationship between doctor and patient. Goetz illustrates how patient data accumulation is critical to the improvement of medical diagnosis and treatment.
Experiences American patients have with doctors are recounted in Topol’s book. One sees themselves in some of Topol’s anecdotes. Doctors are not gods. They are human. They make mistakes. What Topol explains is that mistakes can be reduced with patient involvement in diagnosis and treatment.
Technology is handmaiden to improvement in human health. There are risks and rewards in technological change. The risks are loss of jobs, and diminished self-worth in the short run; in the long run, there is potential for genetic Armageddon from experimentation. The rewards are more leisure time, and improved health in the short run; in the long run, there is greater potential for human survival from genetic modification. Extensive record keeping and algorithmic computerization of human beings threaten the excesses of “1984” but, on the other hand, broadly available information offers opportunity for improvement of the human condition.
At times, Topol seems too optimistic; at other times, too pessimistic. Nonetheless, Topol offers something to think about.