10 Questions You Asked Us In The Q&A

It was a great honor to receive hundreds of questions before the live Q&A we recently had. There were in fact so many that I’ve decided I would share some of them here. These questions represent an ample mix of interests, covering a wide range of issues from A.I. to the future of medical education. And worry not if you haven’t gotten your question answered just yet: in the coming weeks we’ll also be writing articles that are based on some of the most intriguing questions.

Re-watch the event on YouTube:

#1 On The Relationship Of Doctors And Patients

What sort of strategies can we use when the work we did previously relied heavily on the relationships we built and the face-to-face interactions we had with people (which are no longer possible)?

I don't think that the strategy we used to have was the right one. Being able to turn to a physician with every minor medical issue or question that could have been handled by a short digital interaction too. This way, overwhelming medical professionals leads to massive burn-outs. I think we might have the chance to build the right strategy while being forced to move partially to the virtual space due to the pandemic.

I truly believe in the power of the doctor-patient relationship (as I have such a connection to my GP), but I also enjoy the freedom of our online interactions. I think we could build a good relationship in person which allows us to keep on discussing minor issues through digital channels and only meet when necessary.

I'm also sure my GP enjoys this format more than when she had to see 80 patients a day. I might be too optimistic here, but the relationship I have with my GP somehow still proves that this is possible.

Describe the ideal platform for all the wearables to connect with. Bluetooth. Cellular. WiFi?

I understand the technical focus of the question, but I think the ideal platform for all wearables to connect is the doctor-patient relationship. It's much more important that a patient feels they can discuss such issues with their primary care physician than whether their device transmits data through Wi-Fi or Bluetooth. Connectivity is simply an IT issue. The much more complicated task here is allowing the doctor-patient meeting to benefit from the data coming from these wearables.

What promising advancements do you see in point-of-care treatments?

I see exciting portable diagnostic devices that help make patients the point-of-care. I'm especially excited about mobile ECGs that have more and more studies backing their use and portable ultrasound devices. Such devices work by being attached to a smartphone and doing an ultrasound examination on a smartphone does feel like science fiction. I also look forward to testing ultrasound devices with A.I. guidance where the examiner will not even need to be a specialist.

#2 Remote Care – The Best OF All Worlds

Which technology will reshape the capability to care for patients remotely and from home?

Telemedical services, sensors used at home by patients and portable diagnostic devices used by medical professionals are the basic technologies that can augment remote care. All these had already been available, but, especially telemedicine, got a boost during the pandemic and I expect them to keep on rising. With patients using reliable sensors for managing health/fitness and diseases; with physicians using ECG sensors and portable ultrasound devices, patients can really become the point-of-care. And telemedicine is the bridge that connects data measured by these devices and the medical expertise needed to make decisions based on them.

Are there any guidelines when virtual care is more appropriate and when face to face is the better option?

This is an excellent question that raises important issues here. There are minor health issues which could be handled easily only by having access to the knowledge and experience of a medical professional without the need for travelling and waiting. No matter how efficient virtual care services can be, there will always be medical issues from mental health to sensitive topics such as an HIV infection or cancer, where the face-to-face meeting is crucial for the sake of the doctor-patient relationship. Also, when physicians need to examine the patient in a way that cannot be performed through data (measuring an ECG or taking a photo of a skin lesion are possible at the point of care) or have to use big machines, then in-person meetings are the only viable option.

Read more about it here.

Do you think countries will start changing laws to accommodate telehealth instead of physical visits?

The pandemic led to a shift in the approach to remote care as it has been becoming the new norm. To facilitate this, countries do need to create new laws and provide better incentives for their medical professionals. Also, it would make sense to educate the general public about what remote care means, how it works and how it differs from the doctor-patient relationship they are used to. There are already great examples for that – we wrote about them here. 

#3 The Tale Of Tech's Davids And Goliaths

Who is going to bring about the most changes in healthcare: small start-ups with new technology or the Amazons/Google of the world?

Big technology companies have been marching into healthcare for years and we can expect them to either launch their own healthcare services (e.g. Amazon) or to contribute to care with technologies patients and physicians like to use (Apple or Google). Their future role in care is undeniable, however, their experience in regulations and the way the medical community works is very limited. Thus, small companies could address issues specific to a patient population, medical issue or patient need that tech giants have no resources for. This could be a healthy balance between leveraging the power of both.

What does the future of healthcare look like for populations which are not yet tech-savvy?

This is one of the hardest issues to tackle when it comes to the adoption of digital health. There are under-developed regions where we cannot expect patients to become the point-of-care themselves and lead this change due to the lack of resources. In those regions, policy makers have an even bigger responsibility to make it happen. We loved how Rwanda tried to address this.

If you were to do a HealthTech startup today, what area would you choose to focus on and why?

I'd definitely choose a really specific medical or patient need. There are a myriad of companies trying to solve many broad issues of healthcare, but I'd prefer focusing on either a specified patient population or a very specific medical problem.

#4 On Hospitals Now And Ever

How do you believe technology will affect the design of hospital facilities?

I think hospital facilities need to include patient design in their approach. My favorite example for this is from The Netherlands.

The scenery takes place at the Oral and Maxillofacial Surgery Department of Radboud University Medical Centre Nijmegen in the Netherlands. The head of the department, Prof. Stefaan Bergé redesigned his whole department based on the book, The Guide to the Future of Medicine and designed the rooms based on patients’ suggestions. Dr. Bergé said patients asked for the simplest things: to have more privacy, more information and more new games for kids in the waiting rooms – to kill time more easily. They asked for amiable architecture with a lot of light and friendly colors, and round tables instead of the square ones: to put an end to the “confrontation” between the “contending parties” and to have a more balanced patient-doctor relationship.

What will be the role of hospitals in future, let's say 10 and 25 years from now? How will the patient journey change?

The patient journey will definitely move from the hospitals to wherever the patient is. The whole concept of digital health is to make patients the point-of-care. So in 10 years, the concept of patients bringing value to the table through data and their insights will be commonplace, or at least it will be widely accepted. In 25 years, I think only those procedures will take place in a hospital that either require invasive interventions or large machines (such as radiology). Also, we have covered this in more details here.

#5 3D Printing And The Level Of Trust

What recent advancements have you seen in 3D printing of pharmaceuticals at the point-of-care? How will patients be able to trust the quality of these products?

Regarding 3D-printed pharmaceuticals, I have only seen a handful of examples of pharma companies turning to this technology and only in case of certain conditions such as epilepsy where the format of the printed pills allows them to dissolve faster.

I don't think patients need a different level of trust when it comes to the use of these technologies, because regulatory bodies need to maintain the same threshold for every technology and patients only need to put trust in these institutions.

You can read more here.

#6 Entering A New Era With A.I.

How to make sure the hype in healthcare A.I. results in concrete and useful applications in grassroots-level healthcare?

I think the solution for this is threefold. First, we need policies and laws that allow A.I. companies to thrive and do their best. Second, we need to train medical professionals not only to be able to use these technologies but also to be able to assess their quality. Third, we need to educate the general public, including people of media, to have a better understanding of the realistic expectations we can have about A.I.

As a physician, I see a lot of hesitation in the field for people to trust black box algorithms. How do we get the medical community and the FDA to come around to using these tools?

I found the explainable A.I. concept promoted by the American Medical Association very useful in this process of helping physicians gain trust in using A.I.-based technologies. The black box issue is not something we can solve, at least as it seems to me now, thus not even A.I. developers will truly understand how advanced algorithms make medical decisions. But, this didn't only come with the rise of A.I. Physicians make decisions based on technologies they understand how those work or they have a good understanding of how they are supposed to be working, just enough to have trust in them (see the stethoscope or an MRI machine).

I expect the same to apply to A.I. too. The way the FDA has been tackling this is exemplary.

#7 Artificial Intelligence In Medical Specialties

What are future trends in applications of A.I. in long-term care and caring for older adults with dementia?

We published a detailed analysis about how technologies such as smartphones, chatbots, virtual reality, artificial intelligence or smart shoes can contribute to the care of adults with dementia. Focusing on A.I. developments, I expect to see diagnostic applications that could detect the development of dementia early (e.g. based on a phone call) and find better caring environment for them through the concept of the Internet of Health Things, which is only possible if an A.I.-level algorithm can analyse the vast amounts of data those devices collect.

How will A.I. and deep learning influence the activity of radiologists (especially) and other medical specialties, and how will the digitalisation of healthcare impact the doctor-patient relationship?

We analysed this in depth, and in order to help everyone get a clearer picture of how the latest innovations in healthcare impact individual medical specialties, we created an infographic. https://medicalfuturist.com/towards-creativity-in-healthcare-the-impact-of-digital-technologies-on-medical-specialties-in-an-infographic/

At first, we tried to conceptualise what aspects and tasks of the medical job are usually affected by the latest innovations, such as robotics, artificial intelligence, virtual reality, or telemedicine. We have to point out that there is no objective scale to accurately measure these changes, and our conceptualisation is based on observation rather than quantitative weighing.

Still, we found that tasks requiring the collection, analysis, and even the interpretation of information, such as diagnostics in general or radiology/pathology in particular, will speed up due to the use of technologies, freeing up time for other, less data-based duties.

These assignments could mean more interaction-based activities – at the other extreme of our scale –, where the human factor plays a much more important role than machines ever could. Empathy, compassion, creativity and problem-solving skills all bear a part in interaction-based tasks, such as doctors visiting patients, nurses taking care of children, or any other situation in a medical setting requiring the skills, attention, and empathy of the medical staff.

Nevertheless, we believe that after careful consideration of the impact of technologies on these specialties, not only the data- or interaction- based dichotomy could be distilled, but also a move towards more creativity instead of the repetitive, monotonous tasks. For example, in the future, artificial intelligence could free up time for doctors chained to administrative tasks, or various robots, such as the TUG robot, could complete simple assignments for nurses, saving time for patients. Thus, we expect specialties placed on the infographic to heavily “move” towards the creativity endpoint in the decades to come.

#8 Short Stories Of Robots

Robotics seem to proceed slowly in healthcare – what could make it faster to implement robotics?

Regarding robotics, more practical use cases in medicine and care and an increased focus from policy makers could help. The way the Canadian Senate has been handling this, putting emphasis on such technologies and communicating well that they do encourage the use of advanced innovations, is exemplary. But here are a few examples of what I think about robots by playing chess, an analysis of robotics in healthcare and we’ve even written a guide to A.I. in healthcare.

#9 Pandora’s Box And Digital Privacy In It

How do we ensure privacy in the avalanche of digital solutions that surround us? What about people who are criminalised and otherwise marginalised – won't digital medicine lead to their exposure to additional risks?

I think there are three ways to do our best to try to ensure privacy in the digital health era (I wrote doing our best for a reason as I don't see how we can make 100% sure).

One is electing policy makers who understand the importance of privacy in the digital health era and are knowledgeable in this space. A negative example is how the US Senate handled the Facebook hearing.

A second method is assisting medical professionals in acquiring the skill of digital literacy. This way, they could become the guides for their patients helping them avoid the use of technologies that leads to privacy breaches.

A third method is educating the general public. I think this is the crucial component. As long as patients are in charge of how much of their privacy they are willing to give up in exchange for a chance for a better and healthier life, it should ethically be fine.

You can read more about it here.

How do you balance the future of healthcare and consumer privacy? What considerations /risks /opportunities should we keep top of mind?

I believe in the notion that as long as patients are in charge of how much of their privacy they are willing to give up in exchange for a chance for a better and healthier life, we should be fine. If large corporations or governments try to take this freedom of choice away from them, the whole movement of patient empowerment falls to pieces and thus the cultural transformation we call digital health does not take place.

In this, policy makers who are knowledgeable in the digital space can play a huge role, as well as medical professionals who have the skill of digital literacy and educate their patients about what could be safe and what not.

#10 Future Of The Future: Education Matters

What do you think regarding education for healthcare professionals, and what will be the primary way healthcare personnel would like to get the latest news in their field: at live events (as it used to be), at virtual events, or through on-demand ePortals of trusted organisations?

I'm not popular with my opinion when I talk to pharma companies about the future of field force, but I don't see how the method of going physically to physicians showing them study results will remain viable in a post-COVID world. As even medical care moves to the virtual space and physicians will have more time for face-to-face meetings with their patients, I don't think they will prefer spending the time they were looking for so long with pharma reps talking about results on an iPad they can also check out online.

I think the field force will remain strong if they move to the virtual space and be able to offer benefits through that space. In this, they do have to compete with streamers and professional Youtubers. They have to find creative ways of fighting for the attention of physicians. The online space offers a lot more opportunities for that than real meetings.

What single skill do you recommend clinicians start learning today in order to best prepare themselves for tomorrow?

If I had to do it as a clinician, the key skill I think is digital literacy which works as a bridge between the clinical background/knowledge and the digital realm with its own rules. If I feel comfortable in this world with digital literacy, I'm sure I'll better see opportunities that connect the clinical reality to the jungle of digital data.

I really do believe that questions move the world forward. In fact, being a forecaster means asking the right questions – the more thought-provoking the better. No matter who asked, from medical professionals to entrepreneurs, students or patients, I have enjoyed answering every single one of them. So just keep them coming.

Dr. Bertalan Mesko, PhD is The Medical Futurist and Director of The Medical Futurist Institute analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and an Amazon Top 100 author.

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