Technology takeover.

Abstract

A recent editorial on artificial intelligence1 referred to many tasks now based on digital technology. It led me to find a page, reproduced below, which I wrote 25 years ago, in 1995, as the Royal Alexandra Hospital for Children moved from Camperdown to Westmead. I was pleased to see the predicted reliance on evidence, even if some other predictions are unlikely to materialise any time soon. The New Children's Hospital was at the forefront of electronic advances in 1995. But the pace of change over the next 7 years was anticipated by very few people. By 2002, the Departments of Fund Raising, Public Affairs, Information Technology, Cochrane Studies and Multimedia accounted for 85% of budget expenditure. Clinicians have been almost entirely phased out (Fig. 1). Some previous clinicians with computer and survival skills have become protocol writers. All management is by protocol and all protocols are based on outcome studies. All investigations are electronically ordered. For instance, to investigate for short stature, verified age and anthropometric data allow a predetermined set of tests to be done upon the striking of a single key by a certified person (not a medical graduate) after entering correct passwords and family ability-to-pay information. lnpatient beds have been reduced to 95; ward rounds are done not by medical staff (who now sit at computers in a purpose-built institute) but by physical signs clinical nurse specialists equipped with portable ultrasound, CT, MRI, EEG, cardiac echo and other sophisticated devices. Bronchoscopies are done with minimal invasion and airway dynamics alteration by using specially trained ladybirds with xylocaine-padded feet, homing devices, miniature video and transmitting devices (another victory for feminism). All examination and investigation is by protocol. The clinical nurse specialists are cheaper and more accurate than physicians. Much of the surgery is now carried out by robots or by technicians who have been found to be cheaper and often quicker than surgeons. However, surgeons remain in charge of every case, and direct proceedings from their computer and video stations. Robotic surgeons have even been made more life-like, in that they can be programmed to occasionally throw an instrument or shout. Every medical procedure is captured on video with archival storage for subsequent medicolegal proceedings. Outpatient clinics are done exclusively ‘at a distance’. Physicians sit at computer/video terminals where they first assess computer-validated questionnaires. Where examination is considered necessary it is done via the BIOPAW – a remote controlled palpation device with inbuilt ultrasound. Once again continuous video recording and archiving is carried out for medicolegal and other purposes. Such recordings have already been used to defend an allegation of assault by BIOPAW. Patient education is of course by video; pre-recorded automated opinions are generated for any imaginable circumstance and for some unimaginable ones as well. To increase productivity of protocol writers, Cochrane clerks, terminal physicians and surgeons, administration (a most sophisticated computer) has provided incentives such as banking, stock-broking, virtual food and virtual sex without leaving the workplace. Academics no longer have to interact with students, as computers do it better, so they are free to roam the world as long as they log in from time to time. Unfortunately there has been a downside. Virtual food has become so real that some physicians have starved to death. Virtual sex has led to some nasty electrical burns and one death from a heart attack. Too many choices of networks have driven some mad and others to states of useless confusion.