Growing up with a handyman father, I learned everything from basic carpentry to how to winterize an engine. Using his cadre of tools to help build a garage or spray fogging oil into the outboard engine on our small boat or through countless other practical chores, I was surrounded by tools and constantly engaged in learning their uses.
This education sparked a desire to work on complex tasks with my hands and ultimately led me to become an internist (acquiring new skills that gradually replaced the handyman talents of my youth…much to my wife’s dismay). Though I can no longer properly service my own car, my childhood experience remains with me; particularly as I contemplate the current environment surrounding care providers and our era of rapidly advancing technology.
New tools for complex tasks have taken on mythic status these days. In December, the beverage purveyors known as the Long Island Iced Tea company changed their name to Long Blockchain, and the company’s stock shot up 289%. Thankfully, smarter market minds prevailed, but the hysteria over words like blockchain, artificial intelligence (AI), or machine learning is real. I have observed numerous companies, particularly in the health arena, expounding on their use of AI or machine learning as if that “automagically” gives them value. The fact is that these technologies are not panaceas. They are simply tools—no different in their essence than my father’s screwdriver or pipe wrench. Understanding the usage and implementation is a complex and ongoing challenge that brings with it compelling future set of opportunities.
Tools are implements, not solutions. They are insufficient to the task of medical practice on their own. Sure, algorithms can be run independently to diagnose dermatologic issues, perform retinal scans, or serve as imaging readers. But none of that alone solves for the all of healthcare. Tools and technology require a tinkerer, a craftsman, an implementor. The true benefit from new technology will come when we understand how to produce and wield the best of these tools for the broader job of delivering care that is advanced, technical, and human at the same time. I believe that this will happen in medicine, but we still have a long way to go.
The productivity gap in healthcare is no secret, and future technological development should be geared toward shrinking it. Great businesses, significant profits, and new drug and device technology have transformed the industry: Yet we still spend too much and produce too little. Some of this is due to the inherent nature of a complex service—there’s a “human” component and information asymmetry in delivery. The lines are blurred in living a life, managing health, and combating disease—each influences the others in a dynamic continuum. And in medicine, while the introduction of new tools seems more often to lead to a decline in caregiver productivity, it can still produce superior outcomes downstream, thus increasing overall societal productivity.
To wit, before the invention of the stethoscope (celebrating 200 years of existence this year), a physician would visit a patient, take an oral history, listen to the story and consider the symptoms, then give a diagnosis. In aggregate, individuals touched the system with far less frequency and volume. With the advent of the stethoscope, physicians found the new ability to listen to the body as well as the story. The stethoscope in its elegant yet primitive nature as a tool, was a watershed innovation that expanded the medical profession’s understanding of human health, ultimately extending lives and increasing overall societal productivity. This new focus on the collection of objective data to accompany the historically subjective data gathering fueled imagination and innovation. Yet using this transformational tool often leads to additional time, additional spend, and additional personnel—often with the effect of worsening the productivity gap.