We are mostly techno-optimists here at KBGH. We have talked about the possibility of technology saving the aging primary care workforce by augmenting their skills in certain areas. But if you are a techno-pessimist, you might think more in terms of what automation or robots will do to certain jobs, the way factory automation has decreased the availability of jobs in manufacturing. (Or you may worry about safety because of bias in machines or a Tom Selleck-Runaway style robot rebellion. Great movie with Wichita native Kirstie Alley. I digress.)
My training is in endocrinology and metabolism, disorders of the finely tuned feedback loops of chemical messengers in the body. About half of most endocrinologists’ practices is the care of diabetes mellitus, a collection of metabolic defects that cause excess sugar to build up in the blood and cause blindness, kidney disease, and nerve damage, among other devastating problems. When I was in training in the mid-aughts, a big part of my day was spent managing insulin pumps, small pager-sized devices worn by some diabetic patients that deliver precise doses of insulin to meet their dietary and exercise patterns. My job was to observe blood glucose levels the patients took from fingersticks and coach patients on how to change their pump settings. For all their sophistication, insulin pumps were still pretty manual.
In the last few years, though, a new type of insulin pump has emerged. We call them “closed-loop” devices because, when paired with an implanted sensor that constantly tracks the patient’s blood sugar levels, the pumps can make adjustments to insulin infusion rates without the wearer even being involved. For now, the automation in the devices is mostly confined to rates of insulin infusion when the wearer is not eating or exercising. But pumps that can detect food intake and activity and make rapid adjustments are just around the corner. Insulin pumps will eventually use artificial intelligence, complex intelligence uninvolved with messy human emotionality or consciousness, to make adjustments in the background that are seemingly unrelated to our traditional understanding of diet, exercise, or adherence to therapy. Accidentally load your insulin pump with insulin that is slightly out of date and less potent than last week’s supply? The machine may detect it and adjust your rates of infusion to make up the difference. Have a family tragedy that increases your stress hormone levels, causing blood sugars to spike? The insulin pump’s “brain” may be able to detect this and bring your sugars back to normal without your input or recognition.
And this is just the tip of the iceberg in terms of medical technology. Already “decision support systems,” like the alert your doctor gets through her electronic health record to make sure you get your cancer screenings, show small, persistent improvements in overall care. And as we touched on in previous blog posts, robots have proved themselves to be superior to humans in a range of medical tasks, from finding diabetic eye disease to detecting bleeding in brains on CT scans.
All this will require a cultural shift. Often patients express frustration at having “only seen the PA” when they have gone to the doctor, in spite of ample evidence that physicians’ assistants and nurse practitioners provide excellent care, sometimes exceeding the quality of care of physicians in trials. Our culture currently places value on face-to-face time with the physician. And Americans are anxious about the potential safety of driverless cars in spite of the fact that human-driven cars currently kill more than 30,000 people a year. So how will we respond to robots guiding certain potentially high-risk parts of our care like insulin adjustment or detection of bleeding in radiology studies? Maybe we will give them the same brush-off we sometimes give PAs. Or maybe we will accept their input the way we have accepted advertising algorithms from Facebook and Google. It is completely possible that medical professionals will resent medical robots the way we resent automation for taking away factory jobs. To tiptoe into these ideas we will talk about a potential regulatory framework next week.
As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.