Is Dr. Topol a Clairvoyant? — A Book Review about Deep Medicine
Introducing the authors…
Philip Edgcumbe (@Philip_Edgcumbe on Twitter) is a medical student at the University of British Columbia and Diana Hu is a product manager at Telus Health. Our full bios are at the end of this article.
Last month, in the spirit of interdisciplinary collaboration and learning, we got together for coffee to share our respective experiences in different parts of the healthcare industry. In particular, we discussed how Telus Health could better serve both patients and doctors. One of the action items that came out of our meeting was that we would both read Dr. Topol’s newly published book, Deep Medicine. In order to hold ourselves accountable to actually reading the book, we committed to writing a book review together. And, we did it! We’ve each read the book, and our joint book review is below. We’ve written part of the book review individually and part of it together. Our individual contributions to the book review will give you a sense of how reading Deep Medicine impacted how we approach our respective work. Our joint contribution is a more general summary of the content in the book. We hope you enjoy our book review. We’d love to hear your suggestions about other healthcare books we should add to our reading list!
Big Ideas In Deep Medicine
(This section was written by Philip and Diana)
Dr. Topol gives us a glimpse into the future of AI in health with his latest book Deep Medicine. Deep medicine, as defined by Dr. Topol, includes a deep understanding of the patient’s condition based on mountains of data about their health — using the best of integrated health records, digitized diagnostics, AI analytics and much else — as well as a deep personal relationship between the doctor and the patient.
“…as well as a deep personal relationship between the doctor and the patient.”
A key theme throughout Deep Medicine is that AI will never replace doctors. AI will instead, augment their jobs and help move them from behind the screen and keyboard to their original state — looking into the eyes of patients. For example, several companies are working on AI-based natural language processing programs that listens to the doctor-patient conversation and documents the key points. This is just one example of how the doctor-AI hybrid can help create deep medicine and a better healthcare system.
Dr. Topol provides plenty of examples of how AI is being brought to life today. He gives a balanced view of the potential applications for AI, while sharing fair warnings and limitations for the technologies.
One particularly interesting discussion on limitations is about the role of bias in medicine. AI seeks to remove biases that doctors face when diagnosing patients including: availability bias, recency effect, rule-based thinking and confirmation bias.
The impact of bias is misdiagnosis — which according to the book, there are 12 million serious cases of misdiagnosis in the U.S. alone each year.
“…there are 12 million serious cases of misdiagnosis in the U.S. alone each year.”
This represents a huge opportunity for AI to rectify. However, Dr. Topol raises an incisive argument: At the end of the day, doctors are humans and so are AI researchers. What we gain in correcting a doctor’s bias, we trade for potential errors stemming from the subconscious biases of researchers. In short, AI is not perfect, because humans are not perfect. This is one of the reasons why AI cannot replace doctors.
In summary, the advent of AI in medicine will hopefully enable doctors to have more time to get to know their patients.
How will reading Deep Medicine impact my thinking as a physician-in-training and medical student?
(This section was written by Philip, a medical student)
Deep Medicine reaffirmed my belief of the importance of the human touch, empathy and judgement in medicine. I will continue to strive to get to know my patients as people, not as “interesting pathologies” or the “broken femur in bed 3”. Here is a story to illustrate what I mean about the importance of the human connection and human judgement in medicine:
I met Jennifer a few months ago when she came to the clinic where I was working. She is 57 years-old, she loves the outdoors, she has a warm smile and a quirky sense of humour. She’s the kind of person who starts conversations with strangers. As the visit progressed, and we reviewed her medical history, Jennifer shared with me that she had had some back pain a few weeks earlier and gone to the emergency to get it checked out. And, that’s where she learned that she had stage 4 breast cancer. Her back was hurting because the breast cancer had metastasized and spread to her back. When we talked about her feelings about having cancer and her late diagnosis, we actually cried together. We’re going to do everything we can to help her, but she likely only has months to a few years to live. Shortly after her cancer diagnosis, Jennifer had to decide whether or not to take chemotherapy. That decision of whether or not to take chemotherapy is inherently a question of human judgement. Quality of life, end of life, side effects, time with loved ones all hang in the balance.
While it is clear that exponential technology and artificial intelligence will disrupt medicine, the experience that I had with Jennifer reminds us all that one reason doctors will continue to play an important role in our future health care is that humans crave being cared for by other humans. As we disrupt our health care system, we need to leave time and space for the kind of heartfelt encounter that Jennifer and I had. I strive to keep that lesson in mind every time I introduce myself, as a medical student and a member of the medical profession, to a new patient.
“…humans crave being cared for by other humans.”
In addition to highlighting the importance of the doctor-patient relationship, Deep Medicine gave a very comprehensive overview of the strengths and weaknesses of AI as a technology and tool for doctors. This got me thinking about other technologies that have changed how we practice medicine. While this isn’t something that is brought up directly in the book, I think it is important to remember that doctors have been adapting to new technologies for hundreds of years. One fun example, from two hundred years ago, is the invention of the thermometer. When the thermometer was first introduced to medicine in 1717, there was a great debate in the medical field as to its utility. It was met with skepticism by physicians who claimed the numerical nature of the measurement didn’t capture the many nuances of the description of “feverish heat”. Eventually, the thermometer proved it’s worth and no doctor will practice without it now. AI will likely follow a similar trajectory because it too, is just another tool that is been added to the doctor’s toolbox. In fact, Dr. Neil Jacobstein, the Chair of Artificial Intelligence at Singularity University, predicts that within 5 to 10 years doctors who don’t use AI will be sued for medical malpractice.
How will reading Deep Medicine impact my thinking as a product manager in the healthcare industry?
(This section was written by Diana, a product manager)
Deep Medicine is written to meet an audience of all knowledge levels regardless of technical or medical education. So if you are a non-technical and non-medically trained PM like me, you can rest assured this book will still make sense :) Beyond simply making sense, it will impart some serious insight into the impact and potential of AI to transform the health care system and the future products you deliver.
Dr. Topol’s book provides a convincing blend of well-summarized research studies, leading global product examples, and personal anecdotes to convey the power and limitations of AI.
If you have done secondary research as a PM in the health space, you will surely be familiar with the chaotic sprinkling of information across the internet and medical journals. Dr. Topol’s book is a nicely packaged summary of what is happening in the AI cross-section with health.
I’ll share two messages that I took away from Dr. Topol’s book: one for patients and doctors, and the other for PMs.
Doctors and patients have a social responsibility to share health data for the greater good of advancing medicine.
Dr. Topol gives lots of evidence throughout the book to convey the importance of aggregating and sharing our health data to truly unlock preventive, predictive and personalized health for the individual and for humanity.
While the pace of medical breakthroughs is accelerating, there is still a lot in medicine that is unknown. Dr. Topol mentions one AI research study on 1,000 patients which determined that more than 30% of pre-emptive breast surgeries could have been avoided.
AI will help uncover some of these unknowns and reduce unnecessary procedures by distilling data to insights. However, to get to a reliable state, AI algorithms will need billions of data points and clean datasets to learn from.
Therefore, to achieve the vision of personalized health, we will each have a part to play. Innovators, EMR companies and doctors have a critical job to enable patients to access their health data in an easy and meaningful way, and patients have a role to contribute their data to research.
Sometimes the best way to help the patient is to help the doctor.
I have often heard that the greatest tool in a designer’s toolkit is empathy. While we often hear about empathizing with the patient, we have to remember that doctors are a critical part of the equation.
Dr. Topol reminds us that as PMs, we wield tremendous power in influencing the interaction between patients and doctors. As an example, EMRs have unintentionally transformed the doctor visit from listening and relating to patients, to typing notes behind a screen.
As PMs, we have an impactful opportunity to remove the friction of our technology products and revitalize the importance of physical touch and compassion between doctors and patients.
Food for thought: If you’re a PM for a health product, what are some ways AI can be applied to your product to enhance the value for patients, doctors, and society?
Closing Thoughts
(This section was written by the dream team — Philip and Diana)
We both appreciated the comprehensive and highly accessible overview of the applications of artificial intelligence in healthcare that Deep Medicine provides. The book helped us both to better understand the healthcare landscape in which we work and had an impact on how we are approaching our respective projects and careers. However, even if we weren’t both working in the world of healthcare, we would have still enjoyed reading this book because it provides useful information about how the patient experience in healthcare will change in the coming years and how patients can advocate for themselves. For example, some of the AI tools described in Deep Medicine are not available within the Canadian healthcare system. However, a motivated patient could get access to them on their own and then bring that information to their next appointment with their Canadian doctor. As such, we recommend Deep Medicine to anyone who anticipates using the healthcare system or going to see a doctor someday!
Sincerely, Diana and Philip
Diana Hu’s Bio
Diana Hu is a Product Manager supporting the Babylon by TELUS Health product — a mobile app that allows you to check symptoms, see a doctor and easily access your clinical records all through your phone. Diana transitioned to the health space in TELUS just over a year ago after spending 4 years in the telecommunications line of business. She was also a part of the founding team of Illusense — a company developing ultra-high resolution laser sensors for machine vision applications. Her passion lies in solving pain points in the digital health space with design-thinking.
Philip Edgcumbe’s Bio
Dr. Philip Edgcumbe* (PhD) is a Canadian scientist, biomedical engineer, medical innovator, medical student and entrepreneur. In 2017, Philip led a team that developed an XPRIZE crowdsourcing competition to End Alzheimer’s. His team raised $25 million USD to run the Alzheimer’s XPRIZE competition and the Alzheimer’s XPRIZE was selected as the top priority XPRIZE for launch in 2019. Philip is striving to positively impact the health of a billion people by connecting medicine, biomedical research, and entrepreneurship. Philip is a Singularity University Canada Faculty member and he speaks internationally about the topic of disruptive technology and the future of healthcare.
*In the interest of full disclosure, Philip is a self-described “fanboy”, of Dr. Topol. As such, this book review is not entirely free of bias. Dr. Topol’s work as a clinician-scientist, author and thought-leader has been an inspiration to Philip since he started his own journey as a clinician-scientist eight years ago! In fact, Philip, is hoping to have dinner with Dr. Topol one day… and Diana will hopefully be there too!
