On a chilly October afternoon in 2050,
after having watched the leaves falling off the trees from our garden too long to get bored, my beautiful and overtly curious grandchild, Nina, came to me and started asking me questions.
She pointed at one of the many CubeSensors in the living room – small, very simply designed cubes which measure air quality, temperature, humidity, noise, light, air pressure and based on our personal information it adjusts the relevant factors for optimizing our well-being at home – and asked me whether I lived in a house before, what did not have such cubes. When I said yes, she looked at me with wide, marveling eyes and asked me to tell me how I lived when I was young. She liked to ask about the past. I told her about the unbearable heat in third-floor apartments during hot summer nights without proper air-conditioning and the inconvenience it caused when you could not set the right amount of light for working.
Nina was satisfied with my responses, but I had had the impression she still had something on her mind. I asked her about it. She told me that she heard a word from her fellow first graders and she did not know what that was, but one of her friends, Lyanna, told her it was from the age when people did not use smart cubes at home, so she wanted to ask me and make sure I can answer the question. So, I asked her, what that mysterious word was, and she said, hospital.
I laughed out loud. Hospital. I have a grandchild, who does not know what a hospital is. Isn’t she the sweetest (and for that matter the luckiest) girl in the universe?
And isn’t it amazing that she doesn’t know what a hospital is?
So, I told this charming little lady to come over and listen to her old, wrinkle-faced grandpa who will tell her the story of hospitals, doctors, nurses, pills – and pretty much how healthcare used to look like in the 2010s, in the barbaric, pre-technological era of medicine.
More than 40 years ago, patients had to go to huge and unfriendly buildings called hospitals to receive any kind of care and to measure vital signs or health parameters, for example how hearts and brains work. So when people fell sick, they had to go to that specific building instead of just getting care at home or wherever. And there, at the doctor’s office, you could not just go and see the physician. Sometimes you had to wait in line for hours while other people got checked.
Do you remember, Nina, how mommy called up the doctor, she appeared on the screen and mommy showed her your ear when you said it hurt? And she also told her whether you had a fever, and what the device put into your ear for checking it properly, showed? And everything happened in your room, and also your friend, Gregor, the little salamander could be there? I wish it was so easy back in the day.
Mommy told you that this method how you speak with a doctor through the screen is called telemedicine, right? You know, back in the day it was just a shiny new thing which not many believed in. People had to travel from their homes to a different place to receive care. And as doctors where not as widely available as nowadays, sometimes people had to travel a lot. Sometimes by real ambulance cars with real drivers – no driverless cars and no drones delivering medical equipment was available.
You know, Nina, nowadays computers can send each other every health data that you have within a blink of an eye. In the 2010s not every device could communicate with each other, so sometimes physicians did not know about the patients and they had to ask all the data and information that the other doctors and nurses already had. Again and Again.
Moreover, they had to write down all the information, they used keyboards to type down information, not even looking at the patient or talking to them. And I think you are not going to believe this but some medical records were on paper. Yes, people wrote by hand on paper, like you draw those butterflies with the lilac pencil, and those were not even stored or analyzed later on.
Nina, look at grandpa’s digital tattoo on his arm!
Can you imagine that instead of this tiny and shiny metal lamina, doctors used as huge and expensive equipment as this living room? Measuring the electrical activity of your heart (ECG) or measuring blood pressure took time and effort – even for physicians. Medical devices were huge and scary like computers a century ago and patients had to travel to the machines to have very complex examinations, such as the so-called CT scan, by which various photos are taken from the otherwise not visible parts of your body or the MRI which examines parts of the body with the help of a magnetic field. There was also the problem called radiation which means that invisible but harmful energy waves reached the body of the patients.
You know, Nina that you can ask things from your little tablet, and it will eventually find you an answer? Right, I told you already that there is a technology called artificial intelligence through which devices learn a lot about you – like you do about the letters in first grade – and they eventually will give you the solution to problems that might arise. It takes just seconds to find those answers. Now, can you imagine that doctors back in the day had to do searches in huge databases (like Pubmed) to find information somewhere in hidden studies? They had to mine the database themselves and artificial intelligence could not help them? That it would last days or even weeks to read through the irrelevant data to find the right answer?
Also, do you remember that the other day mommy and I went to the pharmacy with you and you observed how the 3D printer machine printed the pills prescribed by your doctor? Now, listen. In the 2010s, medicine was produced by pharma companies who made the same drugs for decades and made the same dosage for millions. Everyone received the same pills – there were no personalized medicine. So, you and Gregor would have got the same, even if you had some kind of allergy and Gregor wouldn’t. There was only one example when a 3D printed drug was approved by the FDA.
I think I also told you some stories about the tiniest bits of our body, the DNA and how with the technique of genome sequencing as they call it, you can get to know more about hidden weaknesses in your organism and use that “secret” data in healing you. Right, Nina? But there was no chance for knowing so much medical information about the person in the 2010s, thus grandpa could have received a drug in a dosage that would have led to serious side effects if he were too sensitive for the particular treatment.
Nina? Are you listening? How come she always falls asleep when I talk about the past? I think these stories are better for her than fairy-tales.
Maybe she is going to be a doctor in the end?
As I was looking at her face with her eyes shut, breathing smoothly in and out, I thought maybe it is for the best that she fell asleep, I have some information about the 2010s which I could not share with this sweet child anyway.
But as I started to think about the 2010s, all kind of memories stormed my mind. I remember how the invention and innovation of new treatments and healthcare methods took forever and the authorization of regulatory agencies even more – some patients literally died while waiting for a new cure. Back in the day clinical trials were long and unbelievably expensive. Moreover, drugs were tested on patients – not on algorithms and physiological models, but real people.
You not only had to stay in hospitals, but infections were commonly acquired while being hospitalized. As there was no algorithm to supervise the process of care, people made mistakes repeatedly. In the 2010s, medical errors were the third most common cause of death.
Hospitals were run by managers not supercomputers. Every decision was subjective and not backed by huge amounts of data. Also, physicians worked in an unquantifiable way. Actually, nobody knew whether they were successful or not.
I recall that epidemiology studies were slow and it took a lot of time to deal with a new infection and develop vaccines in case of epidemics. Cancer was considered a dramatic life event and not a chronic disease for decades. There was no effective cure or treatment for a long-long time.
Health insurance companies mostly lacked of any kind of quantified data. They only knew the age and gender of their insured patients and that’s how they made business decisions. And one of the most important factors: patients were not equal partners of physicians, as they prescribed treatments without asking them.
Well, that’s how I imagine
what would be like when my future self talks to my grandchild about healthcare and medicine “in the barbaric era” of the 2010s. Okay, sometimes I imagine that she does not fall asleep but asks me to bring her some ice-cream.
The point is that I’m optimistic that when I will talk about healthcare in the early 21st century to my kids and grandchildren, they will find many of my stories amusing because they are so unrealistically remote from their experiences. Today, patients are still not equal partners with their caregivers; innovative treatments are not affordable in many places worldwide; and prevention is not even in the top 3 priorities. People do not use cheap sensors to get to know their own health better. Physicians still have to dive into dozens of publications to stay up-to-date when there are millions.
To sum it up, all the technological progress I see as The Medical Futurist makes me say we still live in a barbaric era of healthcare and we have a lot of work to do – such as embracing disruptive technologies, empowering patients, digitizing healthcare information or shifting focus from treatment to prevention – to fulfill at least some of the fantasies above so that the conversation with my granddaughter decades from now might have a similar tone.