Why Vinod Khosla is Right

September 8, 2012

Recently Vinod Khosla, founder of Sun Microsystems, keynoted Rock Health’s Health Innovation Summit where he offered a bleak outlook on the future of the MD.  David Shaywitz at Forbes has some interesting commentary that’s worth a peek.  Davis Liu and Venture Beat’s Matt Marshall offered nice reviews.  Khosla’s Techcrunch piece, Do We Need Doctors or Algorithms, is required reading for anyone with a lens on the future.

Khosla’s recent views on medicine were best summarized by Shaywitz and are as follows (not verbatim):

  1. Medicine needs disruption.
  2. Entrepreneurs focused on consumers are most likely to disrupt.
  3. Since doctors are part of the system that is the problem, they’re not likely to create the solutions.
  4. In the near future, computer algorithms may well replace doctors (80%).

Despite predictable indignation from the medical community, Khosla’s vision isn’t far off the mark. Much of what we once did with our eyes, ears and hands will be replaced by diagnostic and predictive technology.  This is already happening.  The older generation doesn’t want to believe it.  The millennials don’t know anything else.  I might add, however, that I prefer to position the physician’s future as marked by radical redefinition rather than outright displacement.

I do have issue with the growing belief that physicians lack the capacity to participate in shaping or envisioning the future of health.  Our profession is undergoing what may be its most dramatic change in modern history.  I’m confident that a new generation of medical leaders will emerge that will counter current assumptions about doctors and change.

Khosla’s a remarkable guy with some provocative ideas.  I regret that I wasn’t in the Rock Health audience when he challenged physicians to counter his assertions – not because I disagree but because this subject is in need of visible dialog.  My greater regret is that his challenge was met with silence.

And that tells me either everyone’s on board with Vinod Khosla, or there’s truly no hope for our future.


{ 10 comments }

Eric M. Baumel, M.D. September 9, 2012 at 7:07 am

Obviously Mr. Khosla is being intentionally provocative.

I think that what we practicing physicians should take away from this is that perhaps 80% of what we do is better done with technology, leaving us to do the 20% that matters.

We don’t compound our own drugs, do our own Gram stains, or build our own x-ray machines. Let’s use the machine to free us to do what no AI can do. Only a doctor, with our years of training and experience, with has insight into the human condition and the understanding of the natural history of illness.

We physicians need to lead this transition, not be swept away by it.

DrV September 9, 2012 at 3:26 pm

Excellent points, Eric. And the way we react to the changes happening around us will shape what we become.

Ted Leng September 9, 2012 at 3:20 pm

Bryan,
I read the techcrunch article and it is very provoking. I’ll be the first one to speak up and disagree. While it is true that technology will enable faster, better, and more reliable diagnosis and treatment. Those are not the only reasons we all see physicians. It’s the human connection, compassion, empathy, and explanation we seek when we see an MD. We want to know if it’s “going to be alright” or if we’re “totally f****ed.” Once we know this, it is the physician that talks us through it and starts the coping process Anyone who has held a person’s anxiety and fears in their hands can attest to this.

So while it may be faster to get your strep throat diagnosis and antibiotics via cell phone and the Internet, you probably wouldn’t want to have a box tell you about your stage IV cancer diagnosis and what the treatment options are going to be.

While I agree that the role of the physician in diagnosis and treatment may be limited in the future, I think that we will still have a role in the care of the person.

Diane Zuckerman September 9, 2012 at 5:59 pm

Ted,
I couldn’t agree with you more about doctors compassion and empathy, both real and perceived in obtaining better patient outcomes. It is extremely important and necessary for every patient. There are ample surveys validating your comment. I do think technology can assist us all however. I remind us of what Pronovost and others have suggested – we want our pilots to go through check lists before he/she flies us to our destination – why not physicians? With some technological efforts, I believe we can help clinicians with both accuracy and efficiency. Are we there yet? No. But we know technology is an enabler and we know there are individual errors and system errors so if we keep and open mind and work together we might just bring that medical error rate down, lower costs and improve the Dx and Tx in everyone. Personally, not to try is a closed mind. Kudos to Vinod for stepping up!

Diane Zuckerman September 9, 2012 at 6:02 pm

In full disclosure, I have a 10-year interest and investment in this arena – for what I believe is good reason. Let’s not forget a diagnosis of Stage 4 cancer is not what anyone wants to hear when they could have been diagnosed with Stage 1. That is a diagnostic error.

Dr George Margelis September 10, 2012 at 1:13 am

My main issue with Me Khosla’a comments is that just throwing rocks at a problem will make it go away. Provocative comments are fine if they are part of a constructive dialogue. However to make comments like 80% of doctors will be replaced by algorithms without offering any solid examples of this actually happening.

Varadharajan Krishnamoorthy September 10, 2012 at 7:14 am

1. Medicine needs disruption(for a long time now). 2. Entrepreneurs who claim to be in healthcare space, even if they come from other domains, need to enroll enough healthcare specialists to understand better and to get that elusive perspective of consumer focus. 3. 3rd point Well Said and it could help budding entrepreneurs. They should keep this in mind while approaching healthcare solutions. 4. my pov on 4th: “near future” is relative, will happen part by part and a long way for patient participation/acceptance.

Domhnall Brannigan September 10, 2012 at 8:54 am

Ah, but he hadn’t heard of FOAM yet! (Free Open Access Meducation)
http://underneathem.com/2012/08/the-foam-project-more-than-the-sum-of-its-parts/
Doctors ARE changing medical paradigms through education…

Brandon September 16, 2012 at 10:18 am

I disagreed with Mr. Khosla. But I couldn’t reason why. The more I think about it, the more I think he is right.

There is no doubt that the status quo in medicine is not sustainable. Particularly the system.

If we look at innovation, we do notice it doesn’t come from the establishment. Instagram didn’t come from Kodak, the iPhone didn’t come from AT&T, and Sal Khan (Khan Academy) didn’t come from education.

In my experience, I’ve found that most doctors are very conservative, particularly with medicine. They won’t try something new unless there is clear evidence that it works. They want to see the clinical trials, the research, the results and rightfully so. Any mistake in this profession can be deadly.

So I don’t disagree that the “change” we need to see will NOT come from doctors. They have too much at stake. Whereas an entrepreneur generally has little less to lose.

I guess the only thing that I may disagree with is, that 80% of what doctors do will be replaced by algorithms. Several thoughts on this one. If we are able to create algorithms to manage the complexity of the human body, then we could apply the same statement to attorneys, airline pilots, and architects.

Even so, I don’t think that we will replace doctors. We will simply redefine the role of the doctor. Which isn’t a bad thing.

@PediatricInc

Diane Zuckerman September 16, 2012 at 1:03 pm

Brandon,

What a pleasure to hear from an ‘open mind’. Clearly Vinod was being provocative and sometimes that’s what we need. I’d like to put forth that sometimes we we tend to categorize people – Muslims, Jews, lawyers, doctors, teachers, etc., as all the same. As in any labeled group or profession, the ‘members’ are not definitively homogeneous. I don’t think a cosmetic plastic surgeon is necessarily the same person as a pediatrician. I don’t mean to be judgmental but I don’t think one can categorize every doctor as the same.

In my career and experience, there are numerous physicians who are not only open to assistance but much appreciate support for life-long learning and cognitive support, in any format, to help them be better clinicians. If technology is one of those support systems, we should not label or categorize it as the bad guy or replacement of wisdom, empathy and experience, but figure out a way to embrace it, and use it to share one’s wisdom with others.

Evidence comes not just from published randomized controlled trials but from real-world experience – perhaps with a bit of objective and tolerant experience rather than insecure and suspicious rush to judgement, one should strive to venture to a new framework.

I don’t think Vinod or anyone truly thinks we will or should replace doctors – but I do think we all want to be the best of whatever we can be. Challenge is a good thing!!

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