What will the doctor-patient relationship be like in 2028?

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1968: I entered Medical School 57 years ago. Trained in the BC era, my generation today, belongs to the Neanderthal Age. I injected air into the brain, and dye directly into a major artery going into the brain. Displacement of normal anatomical structures was a surrogate marker for a possible brain tumour. Getting the patient’s consent for surgery was a one-sided conversation. No questions were asked. Such was the faith and trust reposed in the surgeon. The role of patient and family in the decision-making process was minimal. We could not share our responsibility with anyone. We were  both Amicus Curae and Devil’s Advocate rolled into one. We entered the brains of our patients, even before surgery, trying to understand what he/she and their families would want, and took a surrogate decision on their behalf, in their interests. It was a one-to-one personal relationship between a patient and a doctor, involving primarily, diagnosis and treatment. I am not sure if today’s medical students are reminded of Sir William Osler’s observations 150 years ago “ — the good physician treats the disease, the great physician treats the patient who has the disease,” and “Listen, listen, listen- he is telling you the diagnosis”. Will such doctor-patient relationships become history ?

2028: Digital Health will be 5P (Predictive, Personalized, Precision, Participatory, and Preventive) medicine with Artificial Intelligence (AI) as a major component. Powerful AI techniques are already unlocking clinically relevant information, hidden in massive amounts of data. Digital Health has a Healthcare Provider, a beneficiary, a 12-digit unique ABHA number, insurance policy coverage, and so on. Preventive healthcare, very early diagnosis, keeping people healthy and promoting wellness – the ‘e-way’ will be tomorrow’s mantra. Digital doctors are experts in deploying telemedicine. They handle connectivity issues, video conferencing systems, apps on smartphones, digital manipulation (pun intended!) UPI, EMR, PHR, HIS etc. The tech-savvy AI-enabled Digital Health clinician runs the risk of becoming dehumanised and depersonalised – no longer the family physician of yesteryear, the be-all and end-all of a family.

In a few years, technology-enabled remote healthcare will be centre stage. Building patient rapport, confidence and trust is vital in a teleconsultation. 5G, 200 Mbps bandwidth, user-friendly intuitive software at both ends, real time access to all relevant medical records, super smartphones or giant screens will help in making the experience of a virtual personal touch, truly memorable. Customer delight should not be the prerogative of virtual shoppers on Amazon alone! Technology is only a means to an end. A fool with a tool is still a fool! SoPs and protocols are at best, guidelines. In healthcare, one size does not fit all. We need to cater to the specific wants and needs of the individual beneficiary, whom we are seeing on a screen.

Producing a “wow” effect during a teleconsult: Infrastructure alone will not suffice. Communication is a dynamic, complex process, a multi-dimensional, multi-factorial phenomenon related to the environment in which an individual’s experiences are shared. Self-learning chatbots and humanoids competing with humans to display empathy and sympathy perhaps may be available in the future – only if the powers-that-be give appropriate weightage to this.

Healthcare is personal: To get 10/10, those treating you from a distance must introduce themselves, make eye contact and communicate what they are doing and why. Recommending cutting-edge, technologically-advanced treatment alone, in a teleconsult is insufficient. A patient’s goals and requirements also need to be factored in. Patients do not care how much you know. They want to know how much you care. 80% of communication is non-verbal, through body posture, voice intonation, the way one looks/sits, attire used, movement of hands and arms and spontaneous smiling. “Bedside” manners need to be upgraded to “webside” manners. Exercising clinical judgement and wisdom contextually, customised for the individual beneficiary, in every single teleconsult, is critical.

The unbelievable progress of digital health globally and particularly in India (one wag opined that AI stands for And India, Always India, Anytime India) should be supplemented with what a doctor has always stood for – “To cure sometimes, to relieve often, and to comfort always”. In my lifetime, using Haptic technology, I may perhaps be able to actually wipe the tears off my patient, in another continent, virtually. I need to understand that even for Gen Alpha born in the digital health era, a comforting word will still make all the difference. This may not come up as a pop screen on the display. This must come spontaneously from the heart (or brain to be precise!).

(The author a former distinguished visiting professor at IIT Kanpur and past president of the Neurological Society of India, the Indian Society for Stereotactic & Functional Neurosurgery and the Telemedicine Society of India. [email protected])