McLEAN

Many readers will recall the day when a visit to the doctor was exactly that. You walked into the doctor’s office, greeted the receptionist (who you had probably known for years), and eventually saw your doc who likely had cared for your family for a generation. As with so many aspects of modern life, this scenario is now drastically different. How often does one get to see an actual physician?

Nowadays, medical care more closely resembles an assembly line. Doctors are just hourly employees, required to see a certain number of patients per hour, their “numbers” monitored closely, part of the factory of modern medical care. But doctors are expensive and the corporations that control healthcare have been looking to improve their bottom line, i.e. make more money, and an obvious approach is to hire less expensive providers.

A clear trend in medicine has been the change in who is providing care. Is a decade of education and training really necessary to “practice” medicine. This is the usual duration to become a physician in the US, from undergrad schooling through residency, regardless of the type of doctor, whether an M.D., D.O., or D.P.M. (although many areas of specialization are much longer).

Today, healthcare is often provided by a nurse practitioner or a physician assistant. The training and education provided for this degree is significantly shorter than a physician who has experience with a great variety of pathologies and diseases. Their training allows them to recognize and accurately diagnose more unusual conditions.

Initially, physician assistants and nurse practitioners worked directly under a physician who monitored their care, the treatments prescribed. But these tight controls have been loosened considerably and many mid-level providers practice quite independently. This has saved millions for the large corporate entities which own the major health systems we are so familiar with.

Part of this discussion revolves around the number of primary care physicians available (who were once termed G.P.’s, i.e. general practitioners). More medical school graduates opt for residency programs leading to specialization than is probably appropriate. But this is a personal choice and is not related to or determined by the need. The funding for residencies is controlled by a variety of factors, many political, and not particularly tied to predicted demand.

Many experts believe advances in technology will continue this trend of automating medical care and reducing staffing costs. Obviously, existing technologies have enabled us to peer into the human body, with MRI an obvious example. We are able to measure a variety of organ systems, from blood sugar to blood pressure and nearly everything in between. Implantable sensors are now available, allowing daily routine monitoring of health and well-being, heart rate and blood chemistry. These can often be measured remotely, the data sent via a cell phone to the healthcare provider.

But significant changes are coming and many Americans will find them undesirable. The day is approaching when artificial intelligence will be handling your healthcare. You’ll electronically check in at the front desk of the local urgent care clinic where an automated system will notify you when your turn is up, providing directions on how to get connected to the sensors and monitors which will be utilized to evaluate your health. A simple logarithm tells the AI what is on the list of possible diagnoses and what tests are recommended to determine the probable cause of your complaint.

The energy requirements of artificial intelligence are significant, and the stress to the power grid will grow exponentially as these systems become commonplace. But machines don’t go on strike, and they don’t complain. And machines don’t get sick, although they do break down on occasion. For those concerned about profit margins, this will be a “slam dunk” once the systems are sufficiently advanced.

Life today is impersonal. Making a call to any corporate entity results in a conversation with a machine and subsequently, frustration because of their inability to understand basic requests. But this trend shows no signs of abating. It will in all likelihood worsen, with fewer humans to interact with. This has already led to increasing feelings of isolation and a loss of “community,” as our interactions are increasingly with AI and automation.

Does anyone think these changes are positive? Will these changes provide better healthcare, or a more accurate diagnosis? These are important questions to which no one yet has an answer. But the human touch is essential to our emotional and psychological well-being and this is being lost as technology encroaches on our life, isolating us and reducing our quality of life. As with so many facets of the modern world, these changes are coming. Maybe it will lead to better healthcare but it seems likely our emotional health will suffer.