In his book ‘La médecine sans médecin’ (Medicine without Doctors) French surgeon Guy Vallancien predicts that the role of the doctor will evolve towards that of guide and advisor. He spoke to L’Atelier about these ideas.
Machines could gradually come to replace doctors, usurping their technical and surgical know-how. However, this could be good news for the patient. Doctors would be more available to counsel and reassure their patients. In this way, machines deployed in the medical field could actually help to bring more of a human touch to the doctor-patient relationship. This is the prediction put forward by Guy Vallancien – a surgeon, member of the French National Academy of Medicine and President of the European School of Surgery – in his book ‘La médecine sans médecin. Le numérique au service du malade’, (Medicine without Doctors: digital technology at the service of the patient) published by Gallimard as part of its ‘Debate’ collection.
In your book you liken the recent significant progress made in ‘connected’ medicine to the impact of the invention of the stethoscope. Faced with the boom in ‘techno-medicine’, you avoid any temptation to give in to self-pity...
Guy Vallancien: Yes, people always imagine that things used to be better in the past. That’s why in my book I remind readers of the tragic episodes we’ve lived through since the year 1000, when cannibalism was rife in France. In Burgundy people ate human flesh because they were starving. People were murdered on the roads and eaten. Human flesh was sold at the market in [the Burgundian town of] Tournus.
At the time all was not rosy in France and we’ve seen enormous progress since then. But that’s as nothing compared with the sweeping changes we’re witnessing in all areas of the human economy today. And medicine isn’t immune to these changes.
By ‘medicine without doctors’ I mean that my brain functions through algorithms. In order to make a diagnosis, the doctor in me goes and searches for various types of information. I aggregate some data, I eliminate others and end up with two or three hypotheses. I’m actually a living biological algorithm. And soon the computer that’s sitting here next to me will replace me.
Could artificial intelligence really work out a diagnosis?
Oh yes, of course.
The patient gives information to the computer, which aggregates it and reaches hypothetical diagnoses. The computer helps me, as it searches for causes which I may be unaware of or may have forgotten. We also see the same thing from the treatment point of view. Today we genotype tumours. We know that the same tumour will metastatise in some patients and not in others. And we can find that out thanks to the genome. As a urologist and surgeon, I’m not able to analyse three billion database items. The computer however, having analysed the data, will be able to recommend such or such treatment.
Technically speaking, I will find myself dispossessed of the tools that used to be part of my job as a physician. On the other hand, the person-to-person relationship will remain. A doctor will always be available to his/her patient who, whatever happens, will never believe the computer. There’ll always be a need for a person to provide support.
‟A machine has the advantage of never getting tired or depressed. Its hands don’t shake. It has a strong point that we don’t possess – i.e. when it doesn’t understand something, it will stop. Human beings tend to forge ahead and push themselves.”
So will the computer be the general practitioner of tomorrow?
Yes, the computer will make ever more diagnoses and will help to decide on the right treatment. Robots are set to develop very, very fast. Twenty years ago I was already using a surgical tele-manipulator. In future robots will be doing some operations all on their own. A machine has the advantage of never getting tired or depressed. Its hands don’t shake. It has a strong point that we don’t possess – i.e. when it doesn’t understand something, it will stop. Human beings tend to forge ahead and push themselves.
A machine has certain advantages. It can help me operate more precisely with my hands. Of course, as a surgeon, I’ll be to some extent dispossessed of my surgical knowhow. But let me say again that what will remain is the relationship I have with the patient who’s having the operation. I’ll become his/her bio-advisor.
We may think we have everything on the Internet and claim to understand everything. But we’ll always need a professional to put what’s happening into perspective. That’s the fundamental role of the doctor, a role which is starting to be lost, under pressure from technology and the pace at which consultations have to be carried out. Medicine needs to slow down a bit.
Will all branches of medicine be affected?
Yes, all of them, and strangely enough, surgery will be the first. Of course there’ll be cases, in trauma situations, for example, where a human surgeon can do better than a machine. A machine can only work in highly rules-based areas.
Especially in urgent situations! Yes, especially in military or terrorist action scenarios, you’ll always need surgeons who are able to operate at top speed. But you have to understand that physicians will in part be stripped of the know-how which up to now has been an essential part of their job.
This is why I talk about ‘media-medicine’. In the past it was my doctor’s hands, eyes, ears which saw and operated, but nowadays it’s the instruments that do that. These days we don’t wait for you to feel a lump in your breast before recommending a mammogram. We don’t wait for complications to arise before diagnosing diabetes through a blood sample. Illnesses are becoming noiseless; we detect them before the symptoms start to cry out. And this is all done by machines.
Doctors will increasingly be handling an instrument panel, just like aircraft pilots.
With this evolution in the doctor’s role, won’t the burden of responsibility have to shift as well? If there’s an accident, who’ll be responsible, the doctor or the machine?
Well that’s already the case, as we’re increasingly surrounded by instruments. We put in prostheses, install pacemakers, and implant a lot of other things. And right there the responsibility becomes a systemic thing– i.e. we look and see whether there was a defect in the device or whether it was badly inserted – i.e. whether the fault was that of the surgeon of the manufacturer. There’s nothing new about this and it will only increase. We’ll probably share the responsibility.
“Our profession could be compared to that of the farmer”
On the other hand, in your book, you point out the danger that this ‘media-medicine’ will turn the medical field into an industry and turn physicians into top managers tasked to hit a set of figures. How can this pitfall be avoided?
Well, we’re basically coming from a tradition of medical craftsmanship. Our profession could be compared to that of the farmer. These are two old vocations. Nowadays farmers also use computers and GPS. Their tractors are automated and their performance analysed. Satellites look right along the fields. And they use drones to determine what type of wheat is growing best. In addition, they can diagnose the effect of the pesticides they use. It’s amazing to see how much the farmer’s job has changed. Medicine’s just the same.
Shouldn’t the doctor of the future also learn to analyse, interpret and manage data? Or will this be left to a data scientist assistant, for example?
Yes, there’s no doubt that the job of physician will be broken up. There’ll be staff working at an intermediate level. Between the nurse with three years’ post- high school training and the doctor with twelve there’s almost nothing at the moment. Midwives have for example a Masters level of education. We need far more people at that level. And there’ll also be engineer operators who’ll be trained up on particular anatomical areas and will be working with particular types of robot. All this will totally disrupt the medical field.
Listen to the interview in audio format here. It was originally aired in French on L’Atelier numérique, (L’Atelier Digital) on the BFM Business channel.