Eric J. Topol, MD

Jan 14, 2013

Why do we need hospitals in the future? Why do we need to have office visits with physicians in the future? That’s really what this segment is about because we know that hospitals are a dangerous place. We know that they are also very expensive. But what’s interesting is that the only reason we would need a hospital in the future is for intensive care units, for someone who is critically ill, for procedures or operations in surgical suites. But why else would anyone want to go to a hospital? We have the technology today to do all the remote monitoring exquisitely and comprehensively at a person’s home, which is, of course, a lot more comfortable, a lot less expensive. Why wouldn’t we use that instead of putting somebody in a regular hospital room? If we have the proper remote monitoring — continuous monitoring if need be — this would preempt the need for going into a hospital unless someone is critically ill.

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Let’s also look at the physician office visit. The average office visit in the United States is somewhere between 7 and 12 minutes, and the average waiting time is about an hour. This is a very inefficient system. Of course, a lot of patients complain that in those 7-12 minutes, the doctor is just pecking away at the keyboard; he doesn’t even look at them. So, it’s a very unsatisfying, unfulfilling type of experience. What if you have — and this has already been piloted by some programs throughout the country — a digital connection with a secure video chat where you are actually having eye contact with the physician throughout the visit, and the visit could even be longer because it’s a much more efficient use of both the patient’s time and the doctor’s time? Yes, you could still have a face-to-face physical visit as need be, but a lot of these visits could be virtual visits in the future.

This could be a very efficient use of time from the doctor’s standpoint: All the vital signs could be transmitted in real time; all the data that could be archived on a smartphone could be transmitted either before the visit or during the visit. Much of the remote technology can be done during the physical exam right in the midst of that 10- or 15-minute encounter. It will be really interesting to see what the role of digital medicine is going to be in the future for both hospitals and physical office visits.

Thank you for joining me for this segment. Stay tuned for more from The Creative Destruction of Medicine.


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