How advances will alter the medical landscape

By Dennis Rosen
June 6, 2011

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The medical advances of the last century have been astonishing, rivaled perhaps only by how much we take those accomplishments for granted without pausing to consider how different our lives would be without them.

Antibiotics and vaccinations that now make infectious disease much less of a threat than before; complex surgeries facilitated by robotics; sophisticated diagnostic tests: all these and more have greatly improved the quality and length of innumerable lives since their introductions.

These developments and discoveries have also altered medicine as a profession. In “Smart Medicine: How the Changing Role of Doctors Will Revolutionize Health Care,’’ Dr. William Hanson, chief medical information officer at University of Pennsylvania School of Medicine, examines how the field has evolved in response to some of these innovations, and the ways in which it is likely to continue to change with so much more coming down the pipeline.

Reminding us that, by definition, disruptive technologies up-end existing paradigms and that years can pass before the results of their introduction are fully felt, Hanson explores the ways in which their outcomes can be both positive and negative. Contrasting the ability of today’s on-call physician to access patient lab results and imaging studies from a computer, with the endless running about of years past, Hanson also describes how patients suffer when physicians who become dependent on all of this information suddenly find themselves one day unable to access it.

Looking forward, Hanson describes the “ICU of the future’’ in which patients are connected to multiple sensors that monitor various bodily functions and that automatically trigger responses to abnormalities, for instance adjustment of flow rate of medicines being administered by drip.

The benefits of this model include freeing up physicians and nurses to concentrate on more complex problems instead of routine care, and for those problems to be addressed immediately without spiraling out of control because a nurse or doctor is busy with other patients. However, there are also potential downsides: How will physicians trained with the new devices and monitors be able to function in their absence, should the power suddenly go out; or if called upon to work in other settings? And what will the implications be for the physician-patient relationship?

Acknowledging that “it is entirely feasible that much of the cognitive work now performed by medical providers will eventually become so objective, precise and encodable that the doctor himself might become obsolete,’’ he continues by saying he does not believe that this will happen, as “the most important element of the interaction between the doctor and the patient is fundamentally human.’’

Reflecting upon how advances in cardiac catheterization have brought about a steep decline in the number of bypass surgeries for blocked coronary arteries and to changes in the physician workforce because of this, he identifies other areas of medical care which could (and are already beginning to) be taken over from physicians by other providers, such as nurse anesthetists and nurse practitioners. If well thought out, expanding this process will not only avoid compromising patient care, but will in fact improve it as patient wait times will be decreased and physicians will have more time to spend with those patients who need them.

The writing is on the wall: Technological advances will continue to transform the way medicine is practiced, and physicians must be adaptive to them so as to provide maximal benefit to patients and to society. Hanson has done a commendable job in describing the processes at work, and for reminding us that the changes in store for all of us have potential downsides, which must be considered alongside the good they will bring.

Dennis Rosen, MD is a pediatric pulmonologist and sleep specialist who practices in Boston. He can be reached at

SMART MEDICINE: How the Changing Role of Doctors Will Revolutionize Health Care By William Hanson

Palgrave, 272 pp., $26