Medicine without doctors: a glimpse of the future

Although there is a great deal of attention on the technological revolution in medicine, little is said about how the role of doctors will change. They are generally very jealous and unwilling to consider any reduction or “field invasion” in their profession.

Yet the development of nanotechnologies, biotechnologies, information technology – artificial intelligence in particular – and cognitive sciences knows no bounds and opens to new scenarios that should stimulate a deep reflection.

History teaches that scientific and technological progress has radically improved medicine and its ability to safeguard and cure people’s health. This is the starting point for an interesting book, “La médicine sans médicin“, written in 2016 by Guy Vallancien, a French surgeon and urologist, a member of the National Academy of Medicine.

Mr Vallancien says that the precautionary principle and the risk phobia that characterises our society should be abandoned in order to radically reform the medical world, from training to remuneration arrangements, including the definition of doctors’ role.

According to Vallancien, the massive use of medical technologies, be they surgical robots, healthcare applications, telemedicine tools, medical images or simply IT resources, should enable doctors to delegate many of their tasks to technicians, nurses and patients themselves. This will allow doctors to focus again on their core business, namely listening, supporting and decision making. The rest of the medical activity, from technical to administrative aspects, will be carried out by the technology itself or by non-medical professionals.

The advent of “media-medicine“, as Vallancien defines the new medicine, will be based on the enhancement and integration of paramedical professions, but also on the creation of new professions, especially operators (engineers) entirely dedicated to the use of technologies.

The book then explores how, according to the author, the health system should be reformed and is above all an appeal for a profound reform of French medicine. But unlike many books of doctors who call for the renewal of their discipline, this is not focused on the defense of the corporation and the traditional role of the humanist doctor in front of sociological, financial or organizational constraints that there are.

As you can easily imagine, the book has given rise to debate and criticism in France.

Returning to the subject of technology, however, there is usually a great deal of caution and attention in pointing out the central and irreplaceable role of the doctor when talking about new medical diagnostics or applications of artificial intelligence. But is this really the case?

There are certainly aspects of the medical profession that, for example, artificial intelligence is not able to reproduce, such as empathy, the ability to a “non-linear” reasoning, the possibility to perform medical maneuvers (e.g. the Heimlich maneuver).

But it is also true that in certain areas where AI can exceed human capabilities, such as image recognition and, more generally, diagnostics or precision in performing certain types of surgery.

It is not a question of putting humans in competition with machines, but of thinking, without prejudice, about how best to exploit the present and future potential of technology to enhance the effectiveness and efficiency of doctors, reviewing their role in a collegial work carried out together with paramedics and technicians.

The chronicle of conflicts between doctors and other health professionals, for example with nurses or radiologist technicians, however, shows an attitude of the medical class aimed above all at defending, in a corporate way, their prerogatives.

If we then add the problem of the shortage of doctors and nurses, which affects both the more advanced and developing countries, it becomes clear that we can no longer postpone a serious reflection on how to plan and implement the future of medicine

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