When is a doctor not a doctor?

It’s Christmas time, so between your meals and movies, why not take a moment to speak to a child and ask them to describe a doctor. What will they say?

They might start by describing someone in a white coat, with a stethoscope, examining a patient in their clinic. They might talk about their paediatrician, or GP, or someone from a hospital. It’s very likely they’ll talk about an in-person encounter, perhaps one ending with a sticker or bravery certificate.

So does a doctor need to physically see a patient to be considered a doctor?

We already have specialities which have little or no face-to-face patient contact. Radiologists, for example, will interpret medical images and reports without meeting the patient in person. Pathologists, who analyse tissue samples and other laboratory tests, also typically work remotely. Public Health physicians and epidemiologists treat entire populations through data analysis and programmes of care.

We’ve also had the rise of telehealth over the past few years. Doctors will now remotely diagnose and treat patients through video and phone calls. This has been especially important during the COVID-19 pandemic, when in-person visits were not always possible or safe. It’s a trend that is continuing, supplemented by a raft of other technologies such as Remote Patient Monitoring, Virtual Wards, and the use of AI to analyse data and predict outcomes on a personal and population basis.

Technology has decreased the need for a doctor to be in the same room as a patient to deliver care. We now face the need to train students, doctors and other health care professionals to be proficient users of technology in their day-to-day practice. Recommendations from the Topol Review of the NHS [1] included building a digital skills framework for those in the NHS to ensure they have the necessary skills to work with new digital technology. This is a baton that has been picked up by Health Education England with the Topol Digital Fellowships [2] and the NHS Digital Academy [3]. Increasingly, medical schools are weaving data analytics and other core Digital Health skills into their curricula.

We don’t just need skilled users. We need skilled builders. We need doctors who are involved from the very beginning in the creation of the products and technology used in healthcare. We need clinician product managers, clinician engineers, clinician designers, and subject matter experts who can work effectively with teams. We need doctors who understand privacy, safety and regulatory requirements, and who can research the clinical effectiveness and health economic impact of the technology we are deploying.

I’m pleased to see organisations like the Faculty of Clinical Informatics [4] lay out core competencies for Clinical Informaticians, but I believe we need to go further, with similar efforts for Clinical Engineers and Product Managers. I sense their presence in the recent reports on “Healthcare Workers’ confidence in AI” [5] as the Creator Archetype: one who ‘Create(s) AI technologies for use in healthcare settings'. I'm seeing it come to life thanks to the work of Dr Rhydian Harris and Dr. Azeem Alam BEM with Bitelabs.io[6], a fellowship that '...(equips) clinicians with the skills, experience, and network to build a career in healthtech.'

In time, I believe this will lead speciation: a distinct sub-speciality within Medicine. One where a doctor practices their medicine through the products that they build, not the drugs they dispense or the consultations they undertake. Their impact will range from the individual patient using a digital therapeutic, through to the global impact of AI-driven risk prediction tools. Their study will bring together evidence based clinical practice and data science, product management, engineering, informatics, and business. Specialist trainees will rotate through non-clinical deployments in startups, data labs, and user research groups.

The past few years have seen rapid change in how digital technologies are being used in healthcare, and that pace is quickening. We need to prepare ourselves for the paradigmatic shifts ahead. This requires a new type of doctor, one that treats their patients with data and digital devices, not just drugs and discussion.

The definition of a doctor is about to change beyond all current recognition.