The Digital Doctor made me do it

Watching some of the NHS Expo tweets this year, from Manchester one assumes rather than from millions of bots in Russia, there was for me a dreadful sense of déjà-vu.

I don’t know whether it was ‘old wine in new bottles’, or ‘same script different newsreader’, but the brand ambassadors of IT and change in the NHS were on message as usual. The “patient leaders” were on message. It was literally business as usual.

I remember going to a seminar in Baker Street in London hosted by Oliver Wyman entitled “The patient-consumer revolution”. The idea that the digital platform can empower good health is nothing new.

With no sense of irony intended, Apple were announcing the new smartphone at roughly the same time as the current CEO of the NHS, a man called Simon Stevens, was relaunching the digital revolution in the NHS.

This is the millionth digital revolution in the NHS. We are, as far as I know, still on course for a ‘paperless NHS’ by the end of 2020. I can’t still get WiFi in the coffee area of my local hospital, the Royal Free in Hampstead, so I was bemused at the euphemistic shill of ‘making the entire NHS estate internet friendly’.

Even patient leaders might become redundant in this new NHS digital revolution. This is because everyone who is wired up to the NHS Digital interface is now a patient. We are all patients, even if we have no overt symptoms. There is no need for ‘patients’, as the word ‘patient’ means suffering, and we all are not suffering.

In a further twist of irony, the face recognition software in the Apple CEO’s demonstration of the security of the new iPhone malfunctioned. This is as reassuring as me downloading confidential health information of my next door neighbour. We all know how well Government has coped with missing data memory sticks, and so forth, up till now.

As argued elegantly by Richard Susskind and Paul Mason separately, such a digital revolution involving automation doesn’t necessarily spell the ‘end of the professions’. For example, I doubt the day of robots whizzing around to manage a cardiac arrest is imminent.

A part of me thinks of the Dragon’s Den question, “If it was such a good idea, why hasn’t it been done by now?” In other words, if somebody had thought that it wasn’t a great use of a junior doctor’s time to spend much time ordering investigations, pushing trolleys or talking blood, after six years of medical school, why hadn’t these jobs been given to someone else by now?

There is a danger of throwing the baby out with the bath water with these types of arguments, however. It’s quite possible that hundreds of thousands of profiles, clusters of cognitive, haematological,  neuroimaging and general clinical data, could be more usefully analysed by a Big Data computer than a single clinician with merely decades of experience, in ascertaining whether someone has dementia or not.

But will the new NHS digital doctor recommend as a matter of automation a cholinesterase inhibitor provided that there are no obvious contraindications? Will this ever need to be signed off by anyone ‘human’?  The question of ultimate responsibility is as yet unresolved, in as much as would you trust an electronic judge to process your bail application, an electronic home office computer to process your right to UK residency as a EU citizen, or your do-not-attempt resuscitation status as an electronic physician?

Answers to questions like this are always thin on the ground from brand ambassadors in trade fairs, and from key personnel at NHS Expo. But it was noticeable that there was much more talk of innovation test beds than real hospital beds at this year’s NHS Expo. Thomas Edison, rather than Florence Nightingale, would have been proud.

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