THE ROBOT DOCTOR WILL SEE YOU NOW...
SATURDAY ESSAY by Stephen Daisley Would you put your health in the hands of a machine? As computers start to outperform human medics, artificial intelligence is already starting to transform the way we are treated when we are ill...
WE’VE all been there – stuck in a heaving waiting room, Jeremy Vine on the radio, over-sugared toddlers chucking toys around and the grinding tick... tick... tick... of a clock that stubbornly refuses to speed up.
Anyone who has had occasion to visit a GP or an accident and emergency department lately will recognise the scene. Patience may be a virtue but, when it comes to our health, our more immediate concern is being seen, patched up and sent on our way.
Time is money and the NHS is no different. A health secretary who cannot get waiting lists down risks public ire, along with gaping chasms in service provision that mean shelling out on locum doctors and private procedures.
Eventually, the minister must bow to popular pressure and loosen the purse strings, which involves unpopular tax rises. The alternative is toughing it out and hoping the public, Press and opposition get bored and move on to some other poor unfortunate. Ask Shona Robison how that worked out.
But there is another way – one that would put an end to long waits, understaffing and bed-blocking. Artificial intelligence could transform the NHS into a lean, hyper-efficient, cost-effective modern medical system. It may sound far-fetched and even sinister but the age of automated medicine is already upon us. The question is, will we benefit from it or retreat through lack of will or vision?
So far, at least 40,000 patients in London have signed up for this brave new world. They are registered on GP at Hand – a chatbot, or online conversation simulator, capable of screening symptoms and referring patients either to a GP for diagnosis or another service.
Babylon Health, developer of the technology, announced last month that the latest version of its app could diagnose ailments with at least as much accuracy as a GP, in some cases more.
The chatbot was tested against 100 patient scenarios and assigned questions from the Royal College of General Practitioners (RCGP) membership exam, the assessment all GP trainees must pass to be accredited. On its first attempt, the chatbot achieved a pass rate of 81 per cent, which Babylon has been keen to contrast with the average score of human GPs – 72 per cent.
THE next generation of GPs could look less like Suranne Jones, star of hit BBC One drama Doctor Foster, and more like an animated robot that pops up on your smartphone. GP at Hand cannot prescribe medicine, for now, but the scope is there to develop products such as this into an autonomous all-round primary care service. In the GP surgery of tomorrow, the app will see you now.
Dr Ali Parsa, founder and chief executive of Babylon, says his company’s product makes primary care more affordable and accessible but not everyone is convinced of the case for robo-GPs.
The RCGP is by no means Luddite but it makes sceptical noises when asked about artificial intelligence annexing large parts of the primary health terrain.
Chairman Professor Helen Stokes-Lampard tells me: ‘No app or algorithm will be able to do what a GP does. Every day we deliver care to more than a million people across the UK, taking into account the physical, psychological and social factors impacting on a patient’s health; we consider the different health conditions a patient is living with, and medications they might be taking, when formulating a treatment plan.
‘Much of what GPs do is based on a trusting relationship between a patient and a doctor, and research has shown that when GPs have a “gut feeling” something is wrong with a patient they are frequently right, despite a lack of obvious clues to a diagnosis.’
Despite these misgivings, momentum is with the tech pioneers. A world of choices is opening up. Apps and chatbots are putting control in the palm of our hand and, once patients get a taste of choice, they will not give it up easily. In fact, they will only want more.
The hospital operating theatre is also at the vanguard of the medical tech revolution.
The da Vinci robot, in use in parts of Scotland, replaces the surgeon’s scalpel with a computer console. The surgeon guides robotic arms, which perform all the necessary moves. This allows operations to be carried out more quickly, less invasively, and patients can be discharged in days.
In the future, surgical robots could be controlled so remotely that the finest surgeons in the United States perform the most arduous operations on patients thousands of miles away in some of the world’s poorest countries. Eventually, surgeons could be removed from the equation – or see their role changed to one of programming and overseeing fully autonomous surgical bots.
Technology is also our best defence against some of the biggest killers out there. One in two Britons will contract cancer at some point in their life and survival rates soar if patients can be treated at a centre of excellence. But there are only so many centres, which cost a pretty penny and must attract the best and brightest in their field.
Step forward Memorial Sloan Kettering, the leading US cancer clinic, and computer giant IBM. Together they have developed Watson Oncology, which runs a patient’s symptoms through a database and arrives at the optimal treatment plan.
At the high-end of oncology, this may reduce the time spent selecting the right treatment from months to minutes. In a field where time is a matter of life and death, programmes such as Watson allow doctors to share information, begin therapies sooner and, it is hoped, improve survival rates.
Imagine what such a system could do for cancer waiting times and survival rates in the NHS. The effect would be transformative. It would be a game-changer and a life-saver.
Meanwhile, in Scotland, the mental health crisis has finally been acknowledged and even assigned a dedicated minister, but progress has been achingly slow.
Support for those who suffer from depression, anxiety or thoughts of self-harm still takes too long to access and too many frontline staff know too little about the subject.
This has been my personal experience, too. I recently asked a GP about cognitive behavioural therapy (CBT) as a course of treatment for severe anxiety. CBT has shown much promise in treating such conditions but I was informed, with a sympathetic smile, that it ‘wasn’t an option’ for me – the waiting time was 18 months.
Another GP was in the middle of prescribing a new medication to supplement a regular antidepressant when I pointed out that the two drugs interacted badly and were not supposed to be prescribed together. Sceptical, she looked it up – sheepishly, she tore up the slip and started again.
Of course, for every troubling experience with the NHS, others will have nothing but praise for care received. But when it comes to mental health, the service still has a lot of work to do.
Once again, artificial intelligence provides part of the answer, this time in the form of Tess – a mental health chatbot designed by San Francisco start-up X2AI.
ITS founder Michiel Rauws drew on his own struggle with depression to devise a bot that talks, listens and processes information like a therapist. Already being trialled in Canada, Tess is more than a Q&A programme: she records patients’ symptoms, emotions and experiences and stores them for future mental health episodes.
Tess remembers which stressors are likely to bring on a panic attack in a given patient and recalls what helped to lift another patient’s mood during their last depressive incident. Patients who lack the time, finances or confidence to see a regular (human) therapist can pull out their phone and be supported instead by Tess.
Such apps could give the healthcare industry the upper hand in the treatment of mental ill-health. For the NHS, it could dramatically cut waiting lists and buy the health service time to retrain medics to deal with mental health patients.
The tide of progress is rapid but turbulent, too. You need not be a clinical expert – or an aficionado of bad science fiction movies – to recognise the dangers inherent in a dreamy techno-utopia of automated medicine.
Would software have built-in assumptions in favour of retaining a patient and therefore not making necessary referrals? How does artificial intelligence replicate a doctor’s ability to spot warning signs of which a patient is unaware? Could an app, with enough autonomy and data, begin to ‘play God’ and ration care according to a patient’s financial burden on the system or estimated longevity?
That’s not to mention the inevitable teething problems when any major tech programme is rolled out – except, with people’s lives on the line, mistakes cannot be undone with the click of a button. Then there are concerns over data security and patient privacy. Theoretically, patients could ‘game’ the algorithm to jump the queue for a hospital referral or to access unnecessary prescription drugs.
These are among the primary hurdles which artificial intelligence advocates must overcome, but most have a technological solution and can be tweaked out of the system as they arise.
More difficult is convincing those wary of the technology. Yes, artificial intelligence could be the saving of the NHS – but for patients not au fait with apps and data and digital doo-dahs, all this talk of robotic surgery and GP chatbots may be confusing and unsettling.
Some are quite content to pop along to visit the GP they have been seeing for 40 years and do not relish the brave new world of Dr Finlay’s Chatbot.
As Professor Stokes-Lampard notes: ‘Artificial intelligence has the potential to transform the NHS, but it must be implemented in an equitable way that enhances traditional GP services and doesn’t benefit some patients at the expense of others. Some patients love technology, but some don’t, and we must ensure that its use does not inadvertently widen healthcare inequalities.’
This is going to take gradual reform, patience, and lots of public information programmes. The human dimension – of patient and doctor – must remain at the heart of the NHS ethos.
Ultimately, however, change is inevitable and technological innovation is arguably the NHS’s best chance of avoiding managed decline. Not only can it slash waiting times, reduce bed-blocking and improve patient care, technology is an answer to an increasingly unsustainable funding model.
Using artificial intelligence to bring patients fast, cutting-edge treatment finally opens up an honest debate about cost. The private version of the Babylon app offers a free symptom checker but charges £4.99 monthly for unlimited access to a real GP. Included in the price are consultations via text message or the video chat software FaceTime, 12 hours a day, seven days a week. One-off check-ups cost £25.
If the NHS can commission apps that meet all the basic requirements for primary healthcare consultations or outpatient services – reducing waiting times and freeing up staff in the process – there is a powerful case for offering patients the choice of faster care subject to a modest monthly fee. The principle of ‘free at the point of use’ would continue, while such a scheme of rolling payments would not be very different from National Insurance, only voluntary.
Here is where the inherent conservatism of the public sector, quietly grinding its teeth up until now, would burst forth in full, Nye Bevan-quoting indignation. Such charges would be ‘a betrayal of the NHS’, ‘back door privatisation’, and all the other maledictions cast in the direction of even modest reform. There would be marches against a ‘two-tier NHS’ and petitions for every smartphone in the land to be smashed to pieces.
It will take a great deal of political will to overcome vested interests and guide new ideas through the swamp of dirigiste group-think that passes for health policy in the UK. Any attempt to secure the long-term future of the NHS through reform, innovation and efficiency is met with wails of odium. Far from ‘saving’ the health service from the wicked Tories or the evils of the profit motive, the reactionaries make it more likely the service will collapse one day.
The Healthcare Quality and Access Index, the annual measure of the world’s best medical systems, places the UK 23rd.
This puts us behind Slovenia, with its mandatory and voluntary insurance tracks, and Sweden, where patients must stump up co-payments to see a GP, visit hospital and even use an ambulance.
The NHS, while a proud national achievement, is nonetheless not the best healthcare system in the world – not even close.
CONFRONTING that reality – and setting aside sentiment and hysteria to accept that, across Europe, universal insurance-based models provide superior quality of care – allows us to ask some taboo questions. Could the NHS be made more cost-efficient, clinically effective and patient-friendly by introducing (modest) co-payments and fees for certain services?
Does artificial intelligence hand us a laboratory to test patients’ receptiveness to charges? Will digital innovation steamroll over barriers to increased private sector involvement in health provision?
This is the real technological revolution in healthcare. An outdated model of funding and provision may not be able to withstand the momentum of rapid change, rising patient demand, and even buy-in by clinicians. If the NHS accepts the need for change, it can reform of its own accord and harness technology to safeguard Britain’s universal healthcare system for generations to come.
If it digs in its heels and puts roadblocks in the way of progress, it makes it all the more likely that the health service will have to undergo radical, painful surgery down the line. Allow the NHS to drift down that path and it will have a great deal less influence over where it ends up.
An NHS powered by artificial intelligence could compete with some of the finest healthcare systems in the world. It would be speedy, nimble and sustainable.
It would give patients the quality of care they deserve. Perhaps most thrillingly of all, we might be able to do away with those soul-draining waiting rooms altogether.