Medicine: What won't change for the next 10 years
Following the methodology of Jeff Bezos
Jeff Bezos focused not on what would change in 10 years, but on what wouldn’t change in 10 years.
For Amazon, there were three things that did not change: Fast delivery, Low price, and Vast selections. At Blue Origin, there were three things that did not change: Cost, Reliability, and On time launches. As he mentions in multiple interviews, by thinking about what won’t change, he could look for the fundamental core value of the business and make long term plans around it.
As an entrepreneur, I decided to follow this methodology into my own field.
As a medical doctor, I spent years thinking about what the "unchanging essence" of medicine is. I have finally formed my answer, and here it is:
Space-time accessibility
Effectiveness of treatment
Preservation of function
If we keep these three enduring values at the center of our approach to healthcare, we will be able to think in the long-term and create lasting values. This is healthcare’s true essence. Let me dive into the details.
First: Space-time accessibility
One-liner: "You can get medical help wherever you are, whenever you want it."
There are hospitals in rural Italy, and there are hospitals in modern Seoul. In ancient Rome, there were hospitals like Hierapolis, and in ancient Korea, there were hospitals in every major village. Even at the early days of mankind there was a shaman in every tribe who also played the role of the medical doctor.
Medicine has revolved around these hospitals. This is because medical knowledge has been a deep vertical that is not accessible to the public. Medical practices have been centered around these "medical hotspots," which inevitably creates a spatial and temporal accessibility vacuum for the public.
People had to walk a long way just to see the face of a famous doctor like Hippocrates. The same is true in the modern society, where the best doctors are already booked for months, even years. This disparity is an intrinsic problem for any specialist-oriented profession, but in the case of medicine the stakes are high for the patient.
In the case of emergency diseases, there is a golden time for intervention. If a patient suffers from ischemic stroke, you have a 4.5 hour window of IV thrombolysis to give him t-PA. If you miss the window, the next one is between 4.5 hour and 24 hours, to try IA thrombectomy, a surgical procedure. The patient’s survival rate and the treatment of choice is dependent on the clock.
Regardless of how much the state-of-the-art modern medicine develops, the patient needs to reach the “medical hotspot” of the society to access the high quality care. Access to care is an unchanging value that has been with us throughout human history, and is one of the fundamentals of medicine.
Second: The effectiveness of the treatment.
One-liner: "My problem will be solved."
Hospitals have two main roles — One is the center of knowledge, the capstone of modern medical knowledge. The other is the site of treatment, the actual act of treatment. This has also been true since the dawn of mankind.
I believe treatment is the more important of the two. “Medical hotspots” are in fact “treatment hotspots”. Patients come to the hospital as a painkiller. They do want a diagnosis, an explanation, and medical knowledge, but they care more about the actual treatment and its efficacy. In the extreme form, if you make a patient choose between knowledge without treatment and treatment without knowledge, most would pick the latter.
So the effectiveness of the treatment is more important than the accuracy of the diagnosis. The urgency and willingness to pay for knowledge is not high. I think this is where most of the digital healthcare services fail to meet the product-market fit. The effectiveness of the treatment is at the essence of healthcare. Without it, medicine would be an academic endeavor with thin real world value.
Third: Preservation of function
One-liner: "I can do today what I could do yesterday."
Imagine a doctor saying, "I can perform surgery to treat your condition, but there is a 70% risk that your vision will be permanently lost as a side effect of this treatment." The risk would be devastating, and it won’t be an easy choice.
Psychologically people perceive losses as twice as big as gains. I would need to gain two million dollars to feel the same way about losing one million dollars.
As we age, we gradually lose functions, and as we get sick, we risk losing our daily function. If I get a mucormycosis infection in my hand, I would need a surgical amputation and lose my hand overnight. This loss of function leads to a great sense of loss that is constant. So all surgeries and treatments are designed to preserve as much function as possible. We all want to live as long and as well as we can without losing function, so this is another fundamental of healthcare.
In the face of AI
I believe these core values to hold to be true in times of technologic advances. These are primary desires of the patient in the face of a major illness. People don’t want to be sick. People want to go back to their normal lives. People want effective care when and where they want. These are fundamental needs.
I believe in a future where technology augments these core values of medicine. I believe in a future where these medical needs are better realized through IT and software. It is the future I’ve bet on since I was 17 years old.
In the case of AI, I believe it could greatly increase the accessibility of medical knowledge, and in certain areas provide an effective treatment. I believe this future would come in our lifetime.
It is a risky bet, but it is important enough to humanity to risk failure.
If this vision excites you, join me on this bold mission. Let us make history together.