Diseases are being diagnosed earlier and more accurately than before. The advances being made will eventually enable preventive healthcare.
In the future, the role of doctors will change from making diagnoses to supporting the patient and preventing or stopping the advance of diseases.
Wouldn’t it be great if serious illnesses, such as diabetes and heart disease, could be diagnosed and treated before the patient develops any symptoms? How many unnecessary aches and pains – not to mention tests – could be avoided?
Technological progress might soon make this possible. An electronic nose may detect prostate cancer from a patient’s urine and a sensor integrated into clothes or a sticking plaster might discover arrhythmia. In the future, diabetes, asthma and lung cancer may easily be diagnosed from exhaled breath.
Studies have already shown that all of these scenarios are possible. The next step will be to apply the relevant technologies in a judicious manner. Technological developments will change both the diagnosis and monitoring of patients. Diseases will be discovered earlier – perhaps even prevented – and they will be treated with greater efficacy, meaning people will spend less time in hospitals.
The traditional pathway of first visiting the doctor to report one’s symptoms before being sent to the laboratory for tests will become a thing of the past. The monitoring will instead be continuous and done at home: real-time data will be compared to the patient’s lifestyle and, for example, his or her daily rhythm. Only if irregularities arise in the monitoring will the patient get an appointment with a health professional.
All sorts of equipment and applications for measuring health and well-being are already available. For example, different kinds of sensors that measure heart rate are installed in watches. However, the problem with these applications is that there is a lot of extra “noise” around the measured signal. In addition to the heart rate, a sensor in the watch easily reacts to the movement of the wrist. Another problem is that the applications do not communicate with each other. After all, integrating information from different sensors is complicated.
Thus, the aim is to create a new generation of monitors that measure uninterrupted signals and interact with each other. According to Niku Oksala, associate professor of vascular surgery at the University of Tampere in Finland, new and even unexpected technologies will be needed.
“It is obvious that the sensors will be located in other places than the wristwatch,” Oksala says.
The next megatrend will be to conduct the monitoring unnoticed. Experiments with intelligent clothes and plasters have already been undertaken, and radar may also turn out to be helpful.
“They may enable the patient’s vital functions to be measured from a distance. For example, sensors may be installed in the home of an elderly person to measure heart rate, respiratory rate and movement within a five-metre radius. If an elderly person falls down, the sensors may detect the fall from changes in the person’s vital functions and raise the alarm,” Oksala explains.
In the hospital environment, augmented reality might help to monitor patients. For instance, nursing staff could be able to see the patients through walls and view relevant monitoring information regardless of time or location.
“This would enable people’s powers of observation to be put to the best possible use,” Oksala says.
Different patient groups can also benefit from augmented reality. For example, signals from the environment could be reproduced for the hard of hearing or blind in order to facilitate their coping and navigation.
“Rehabilitation is another area that could be aided by augmented reality. Patients could use virtual reality goggles to watch a physiotherapist demonstrate exercises. After that, the equipment could monitor the movements and show the desired and actual trajectories of the exercises. Finally, the programme could reward the patient for the successful attainment of the set objectives,” Oksala explains.
However, technological developments are also associated with risks. When anyone is able to measure anything, there is a risk that the measurement will go overboard.
“The aim is to improve the quality of life, not to burden and worry people with unnecessary monitoring,” Oksala stresses.
The burden on health care may increase due to growing numbers of patients, as asymptomatic patients will start to present previously undetected illnesses.
“In those cases, someone has to decide who will be treated and when. This requires the awareness of the medical staff, people who are able to put the diseases into a proper context and interpret the various implications,” Oksala says.
Taking the context into account and making the correct interpretation of the early findings would be useful, as doing so could result in savings in the last few years of treatment, which are often the toughest and most expensive. Such knowledge hubs as the new Tampere3 University can be valuable in this respect.
“Tampere3 will be an excellent forum because it will combine technological know-how with ethics, behavioural sciences, medicine and health care. It will help to develop effective and safe treatments,” Oksala argues.
Oksala also calls for cooperation with the technology industry. New technologies provide new business opportunities, and – since the context is health – such business must be ethically sustainable.
“Tampere3 could form a network of experts to support business development in health technology and act as a critical filter for businesses. The network could be involved in testing new equipment and developing solutions that are beneficial and ethical,” Oksala says.
In the future, the role of doctors will also entail helping patients keep their technical purchases to a sensible level. The health technology industry would surely be happy to see patients as their clients too.
“However, a patient is often not a client deciding solely on health-related purchases. The patient may be confused and depressed about his or her illness and require comfort and empathy, and he or she relies on the doctor for these issues. Such feelings are not sold online, so the doctor should help the patient cope with the turmoil caused by the disease without extra cost,” Oksala explains.
According to Oksala, doctors in the future will rather be coaches instead of experts who have an opinion on the patient’s condition. For example, “chat bots” – which provide the patients with a diagnosis, give advice on home care and engage in intelligent dialogue – might issue opinions on the patient’s health. In the future, the job of the doctor will involve supporting the patient.
“What has already happened in medical training will also happen in health care. Previously in teaching, the teacher had all the information, which – if it was a good day – he or she kindly shared with the students in lectures. They tried to transfer multi-dimensional information from one brain to another via speech. This has now changed; the teacher is no longer an authority, but a manager who facilitates the students’ acquisition of knowledge and provides them with the best possible tools. The same will happen in the future in the physician-patient relationship,” Oksala predicts.
Patients are also likely to commit to treatment more actively if their role is more prominent and they are encouraged to acquire high-quality information about their condition.
“The job of the doctor is to help the patient choose information that is really helpful. The doctor encourages and supports the patient and interprets the information,” Oksala explains.
This also requires changes in the medical mindset. The medical profession has traditionally been very conservative, and doctors have enjoyed a high degree of authority in relation to both patients and other health care personnel. Technological developments may make doctors descend to the level of ordinary people. According to Oksala, this will not be a problem for future doctors.
“Those who apply to study medicine are mostly people who want to help others. They have to understand that the ways to help the patients will change over time. I would imagine doctors will get more pleasure from helping the patients – even with technology – than from being categorically right,” Oksala says.
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- Oksala is associate professor (tenured) of vascular surgery at the Faculty of Medicine and Life Sciences at the University of Tampere, an adjunct professor of surgery and experimental surgery, a Doctor of Medical Science and a Doctor of Philosophy.
- He leads and studies developments in the diagnosis of surgical conditions, perioperative monitoring and risk assessment utilising novel sensor technology as well as computational applications in MADDEC (MAss Data in the Detection and prevention of serious adverse Events leading to complications in Cardiovascular diseases), which is funded by Tekes – the Finnish Funding Agency for Innovation, and in the Academy of
- Finland-funded project VBA (Vascular Biomechanics Assessment).
He is a member of a working group that is developing an electronic nose for detecting cancer cells.
Text: Hanna Hyvärinen
Photographs: Jonne Renvall