Reviews

In his book, The Creative Destruction of Medicine: How the Digital Revolution will Create Better Health Care, Eric Topol, chief academic officer for Scripps Health, a non-profit healthcare system based in San Diego, argues that the digital revolution can democratise medical systems in a groundbreaking way. The creative destruction in the book’s title comes from Austrian economist Joseph Schumpter, who popularised the term “creative destruction” to denote transformation that accompanies radical innovation.

Topol boldly predicts the end of ‘one-size-fits-all’ medicine; instead patients can look forward to personalised and customised solutions for their health problems. It is almost Nirvana-like: as we collect ever more complex medical data about ourselves we can look forward to more personalised care at the point of delivery.

Informed consumers will be in the driving seat, controlling their own healthcare based on genomic information and real-time data obtained wirelessly through nanosensors.

Social networking will play a major role as ever-widening online health communities provide us with peers whom we never meet

Social networking will play a major role as ever-widening online health communities provide us with peers whom we never meet but who become crucial guides as we come to terms with our illness.

Topol really is convincing on the technological aspects of this coming revolution. But readers may have greater difficulty envisaging the consultation of the future. What will happen in the valuable crucible of the doctor – patient interaction?

In the years ahead Topol says he expects up to 70% of office/surgery visits will become redundant, “replaced by remote monitoring, digital health records and virtual house calls”. But there is no convincing narrative to back this up, leading this reviewer wanting a follow-up volume in order to be entirely convinced that Topol’s transformation can work in the trenches of frontline medicine.

Although his book may at first glance appear to be aimed at business people and economists it gradually becomes obvious that absolutely anyone could relate to the book’s principal ideas, and could benefit from an understanding of the psychological theories described. As doctors we need to make quick decisions about patients as well as the interpretation of clinical information and statistics. We expect our decisions to be based on experience, intuition and knowledge. However the conclusions each person draws are different and this book clearly describes the possible reasons why.

Our brains are tainted by presumptions and are subconsciously influenced by what we are exposed to in our daily lives. This is partly about cognitive bias, which Kahneman describes in the first part of this book. If you are a person who questions what is happening around you, and is interested in understanding your own thought processes with a view to improving judgment, you will be enlightened.

Absolutely anyone could relate to the book’s principal ideas, and could benefit from an understanding of the psychological theories described

Take for example the effect of cognitive bias: it can lead to mistakes, inaccurate judgments, irrational behaviour and illogical conclusions. Perhaps we know that we are influenced by what is around us – that isn’t a new idea – but what is so powerful about this book is that it points out totally unexpected and unpredictable influences on our state of mind. When a patient walks into a room there are hundreds of reasons why you may come to a conclusion – by understanding those reasons perhaps you can check yourself – that is, think slow, rather than fast, and make better judgments.

The reader may be put off by the potential of complex ‘science bits’ and long words – this is not something to be worried about. It is a bestseller because it is accessible, written in an informal way, each chapter peppered with example questions, scenarios, and details of experiments that clarify the arguments made for each of the theories.

Today our minds are heavily bombarded by mass media and marketing, and Kahneman’s book also helps us unravel the decisions we make outside the workplace. After reading the book perhaps having an understanding of these shortcomings will make us question our decision-making, our behavioural responses and our confidence in judgments, but hopefully in a positive way.