When is a Doctor Not a Doctor?

Ask a child to describe a doctor. What will they say?

They might start by describing someone in a white coat, with a stethoscope, examining a patient in their clinic. They might talk about their paediatrician, or GP, or someone from a hospital. It’s very likely they’ll talk about an in-person encounter, perhaps one ending with a sticker or bravery certificate.

So does a doctor need to physically see a patient to be considered a doctor?

We already have specialities which have little or no face-to-face patient contact. Radiologists, for example, will interpret medical images and reports without meeting the patient in person. Pathologists, who analyse tissue samples and other laboratory tests, often working remotely, also typically work remotely. Public Health physicians and epidemiologists treat entire populations through data analysis and programmes of care.

We’ve also had the rise of telehealth over the past few years. Doctors will now remotely diagnose and treat patients through video and phone calls. This was especially important during the COVID-19 pandemic, when in-person visits were not always possible or safe. It’s a trend that is continuing, supplemented by a raft of other technologies such as Remote Patient Monitoring, Virtual Wards, and the use of AI to analyse data and predict outcomes on a personal and population basis.

Technology has decreased the need for a doctor to be in the same room as a patient to deliver care. We now face the need to train students, doctors and other health care professionals to be proficient users of technology in their day-to-day practice. Recommendations from the Topol Review of the NHS included building a digital skills framework for those in the NHS to ensure they have the necessary skills to work with new digital technology. This is a baton that has been picked up by Health Education England with the Topol Digital Fellowships and the NHS Digital Academy. Increasingly, medical schools are beginning to weave data analytics and other core Digital Health skills into their curricula.

We don’t just need skilled users. We need skilled builders. We need doctors who are involved from the very beginning in the creation of the products and technology used in healthcare. We need clinician product managers, clinician engineers, clinician designers, and subject matter experts who can work effectively with teams. We need doctors who understand privacy, safety and regulatory requirements, and who can research the clinical effectiveness and health economic impact of the technology we are deploying. If we want these to be deployed in the workplace, we need doctors who understand who to implement and lead change.

I’m pleased to see organisations like the Federation for Informatics Professionals and British Computer Society lay out core standards for Informatics Professionals, but I believe we need to go further, with similar efforts for Clinical Engineers and Product Managers. I sense their presence in the recent reports on “Healthcare Workers’ confidence in AI” as the Creator Archetype: one who ‘Create(s) AI technologies for use in healthcare settings'. I'm seeing it come to life thanks to the work of Dr. Azeem Alam BEM and his team with Bitelabs.io, at which I am a regular speaker and advisor. They offer an 8 week fellowship that '...(equips) clinicians with the skills, experience, and network to build a career in healthtech.'

In time, I believe this will lead to speciation: a distinct subspecialty within Medicine. One where a doctor practises their medicine not through the patients they see, but through the products they build.

Their impact will range from the individual person using a digital therapeutic, through to the global impact of AI-driven risk prediction tools. Their study will bring together evidence based clinical practice and data science, product management, engineering, informatics, and business. Specialist trainees will rotate through non-clinical deployments in startups, data labs, and user research groups, developing deep hybrid skills and knowledge, invaluable to teams building Healthtech products and services. 

The past few years have seen rapid change in how digital technologies are being used in healthcare, and that pace is quickening. We need to prepare ourselves for the paradigmatic shifts ahead. This requires a new type of doctor, one that treats their patients with data and digital devices, not just drugs and discussion.

The definition of a doctor is changing beyond all current recognition.

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