2020 is upon us! The subject of many a science-fiction feature of yesteryear, 2020 is a year we once may have envisioned humanity existing in Blade Runner-esque cities, with genetic engineering rampant and robots commonplace. It's fair to say that we aren't living in a world as advanced as that, but one that is probably as dystopian and confusing.
Healthcare is a microcosm of the state of the world, and if the last decade is anything to go by, we need to be braced for an impending era of dramatic change. For decades past, doctors have had to adapt to the changing face of medicine – new fields have emerged, new modalities have surfaced and new knowledge has been created. But the advent of the 2020s carries with it the possibility of the most fundamental change of all – the possible shift away from the doctor.
We already see changes all around. The rise of telemedicine services has brought into question the need for the traditional brick-and-mortar clinic. Improving patient knowledge means that the doctor no longer has a monopoly on medical knowledge, and with it, there is a need for more shared decision-making. A greater respect for patient autonomy means that patients, and not doctors, are increasingly becoming the main decision makers on medical matters. The advent of artificial intelligence (AI) and apps that can track everything, from our vital signs to our mood, begs the question of whether eventually, the doctor, that physical human being bestowed with the responsibility of being a guardian of health, will eventually be replaced.
The twin threat to the existence of the doctor stems not just from AI but also from the burgeoning prominence of alternative facts. Whereas once statements based in fallacy were beliefs held by a fringe, we now see entire societies and leaders base their policies and decisions on a set of information that deviates from the body of truth, held with a deeply entrenched conviction. Perhaps the rise of egocentrism has convinced people that a commonly held truth is non-existent, and what is true is only what we ourselves perceive to be true. While this divergence from the truth is at times comical and at other times controversial, when it comes to healthcare, it can be catastrophic. When people no longer believe in the facts of medicine, they make contrarian decisions that may no longer be in their own best interests. These decisions can be harmful to themselves, their families, and in the case of the anti-vaccination movement and the loss of herd immunity, the community. It is ironic that in the day and age of globalisation and rapid development, we see age-old diseases that were once eliminated due to vaccination, re-emerge due to fervent beliefs based in fallacy.
Doctors also now work in a more complex environment of greater administration and legislation. While regulation, by curbing errant practices and ensuring safety of patients and research subjects, is a good thing, an overly litigious environment may have the opposite effect on patient safety. Afraid to venture into new areas of research due to substantial red tape, or wary of trying new procedures due to the risk of litigation, doctors may stick to the tried and tested, and the medical field may thus become stagnant and sclerotic. When the endeavour to reach new shores is one that is hindered by rampant red tape and constant legal risks, the temptation to stick to familiar, and possibly safer (for the doctor) shores may prove to be overwhelming. This is to the detriment of medicine and to society.
What is one to make of the decade just passed? We entered 2010 excited about the prospect of an interconnected world and beginning our embrace of social media. We end it with greater physical connectivity but with a contagion of loneliness and yawning divisions. Perhaps though, with undying determination and an unyielding will to work towards a better tomorrow, healthcare and humanity shall prevail through these dark times.