January 14, 2015 | Eric Topol is a Scripps Translational Science Institute cardiologist and self-professed technophile, but this is not just a book about technologies.  Rather The Patient Will See You Now argues that patient engagement and the end of medical paternalism are key components of 21^st century healthcare. 

Topol’s previous book, The Creative Destruction of Medicine: How the digital revolution will create better health care, discussed the large number of patients for whom “one size fits all” medications are ineffective (or toxic). In Creative Destruction, Topol provided a nuanced assessment of the role sequencing will play in the increasingly intertwined fields of diagnostics and therapeutics, but the increasing presence of the patient will just as dramatically change medicine.

Technologies—especially smartphones and wearable sensors—offer cheaper and more ubiquitous diagnostic and monitoring capabilities, accessible even to the homeless and people in developing countries. Topol does not shy away from complex issues such as the challenges of data privacy, security, and sharing.

The patient has never been more isolated or more connected than now.

Equipped with electronic medical records and health information technology, we are beginning to better able detect individual drug toxicities, which rarely emerge until drugs are used in large numbers of patients after clinical trials.

Complex chronic diseases are an increasing part of medical needs (and costs). There are tradeoffs as we make progress in curing or preventing diseases. The remarkable twentieth century increase in average lifespans is tied to the increase in late onset dementia. 

Topol recognizes that overuse of antibiotics leads to drug resistance, and particularly dangerous nocosomial infections in hospitals. Overuse of medical imaging can result in potentially carcinogenic radiation exposure, which can be somewhat mitigated by electronic medical records and less need to repeat previous tests. And overuse of diagnostic tests leads to false positives and findings of incidental or unknown significance.

The US spends more on healthcare than any other country, often with indifferent results. Finding the appropriate balance between interventions and watchful waiting, respecting patient priorities and autonomy, while providing guidance (and comfort) when prevention and cure are not options is and will continue to be challenging.

Perhaps the greatest challenges ahead—both for patients and health professionals—will be learning to manage uncertainty and expectations.

This is a well-documented and thoughtful look at current and future medicine. It is complemented by books such as Atul Gawande’s Being Mortal: What Matters in the End. (Metropolitan, 2014)  

Mortality—and nothing else—is still 100% certain. 

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