The Patient Will See You Now: The Future of Medicine is in Your Hands

by Eric J. Topol

A trip to the doctor is almost a guarantee of misery. You'll make an appointment months in advance. You'll probably wait for several hours until you hear "the doctor will see you now"—but only for fifteen minutes! Then you'll wait even longer for lab tests, the results of which you'll likely never see, unless they indicate further (and more invasive) tests, most of which will probably prove unnecessary (much like physicals themselves). And your bill will be astronomical.

In The Patient Will See You Now, Eric Topol, one of the nation’s top physicians, shows why medicine does not have to be that way. Instead, you could use your smartphone to get rapid test results from one drop of blood, monitor your vital signs both day and night, and use an artificially intelligent algorithm to receive a diagnosis without having to see a doctor, all at a small fraction of the cost imposed by our modern healthcare system.

The change is powered by what Topol calls medicine's "Gutenberg moment." Much as the printing press took learning out of the hands of a priestly class, the mobile internet is doing the same for medicine, giving us unprecedented control over our healthcare. With smartphones in hand, we are no longer beholden to an impersonal and paternalistic system in which "doctor knows best." Medicine has been digitized, Topol argues; now it will be democratized. Computers will replace physicians for many diagnostic tasks, citizen science will give rise to citizen medicine, and enormous data sets will give us new means to attack conditions that have long been incurable. Massive, open, online medicine, where diagnostics are done by Facebook-like comparisons of medical profiles, will enable real-time, real-world research on massive populations. There's no doubt the path forward will be complicated: the medical establishment will resist these changes, and digitized medicine inevitably raises serious issues surrounding privacy. Nevertheless, the result—better, cheaper, and more human health care—will be worth it.

Provocative and engrossing, The Patient Will See You Now is essential reading for anyone who thinks they deserve better health care. That is, for all of us.

Genres: Health Care, Nonfiction, Medicine, Health, Science, Technology, Medical

384 pages, Hardcover

First published January 6, 2015

Reviews

[Dr. Appu Sasidharan (Dasfill) · Rating 3 out of 5]

Summary

Dr. Eric J. Topol is an American Cardiologist who completed his Medical education from Universities like the University of California and Johns Hopkins University. He is the editor-in-chief of Medscape and is holding several positions in various institutes. When a person of his stature writes something about Medicine's future, we are sure that we will get some important information from it. This book tells us how smartphones and artificial intelligence can revolutionize the future of Medicine. He calls it the "Gutenberg moment" of Medicine. There is a relevant complaint among people that medical records' digitalization has made Doctors more mechanical and less human. Will further digitalization make Doctors more mechanical? The author tries to answer that question through this book.

What I learned from this book
1) Flipping in Medical education
The Pandemic forced many countries to undertake this method in Medical education. When we try to implement it in Medicine, there are many demerits as direct patient contact is an integral part of medical education.

“There is a new phenomenon known as “flipping,” whereby students can listen to lectures at home or on the go, but come to class for an interactive, non-lecture experience.”

2) Smart phones and Medicine
Smartphones have the propensity to revolutionize Medicine if it is used in an ideal way. The author discusses it in detail in this book.

“There is the chance that smartphones will democratize medicine. That will ultimately be achieved when each individual has unfettered, direct access to all of their own health data and information. Or captured by the popular mantra "nothing about me, without me."

3) Angelina effect
Angelina Jolie has an admixed European ancestry. Her mother died in 2007 due to ovarian cancer. Her mother also had breast cancer, and her grandmother also had ovarian cancer. Due to the family and ethnic risk factors, she decided to undergo BRCA tests to know whether she had a chance of developing cancer like her parents and went for a mastectomy when she found out about her risk. A study conducted by BMJ found this

"The findings, published in The BMJ, revealed a large spike in genetic tests for a gene known to increase breast cancer risk following Jolie's op-ed, but no corresponding uptick in mastectomy rates, suggesting the tests did not lead to increased breast cancer diagnoses.

The results illustrate that celebrity endorsements can fuel the use of health care services but may not effectively target the populations in greatest need of such services, the researchers said."

The author's opinion about its global impact is also critical.

"We have to say that Angelina effect had a global impact. In my view, the real effect has little to do with the media broadcasting a story about genomic screening and a star. This is a huge landmark story about self-determination in Medicine. ”

My favourite three lines from this book

"We believe that digital health technology can serve as a powerful equalizer for improving health education and access to care among minority and low-income communities by reaching people where they are spending time—at school, at church, in their neighborhoods and on-the-go with real-time solutions that easily fit into their daily lives."

“The portability of the book, like that of the easel-painting, added much to the cult of individualism.”

“Based on this sort positive data, Leonard Kish, a health information technologist, has rightfully called the engaged patient the “blockbuster drug of the century”

What I didn’t like in this book
The Healthcare system is not just Doctors and Patients. Many other people like Nurses, technicians, pharmacists who are equally important are almost entirely ignored in this book. I think the author could have mentioned a little bit more about their role in the future of Medicine instead of being reticent about them.

This book should have been a convincing polemic that revealed the vested interests of rapacious individuals like Elizabeth Holmes and large corporations to convert Medicine into a money-churning unit in the name of impractical modernization. The author tries to mention it, especially the corporates milking medical research as a money source. I think the author should have gone a little more deeply into that topic. In some areas, the author goes overboard to the Quixotic level instead of being pragmatic.

Rating
3/5 If you are a Doctor working in the United States, this is a must-read book. The author has successfully scrutinized many vital ideas also from a patient's point of view. So it will be a good pick for anyone interested to know how our healthcare will look like in the future.

[Lindajacob · Rating 4 out of 5]

I came to know about this book through Prasad Kothari's book on Healthcare Social Media Management and Analytics: For hospitals, Insurance companies, Pharmaceuticals, Public health professionals - https://www.goodreads.com/book/show/2... Both are such wonderful books. Amazing authors.

[Laura · Rating 2 out of 5]

Topol is quite the cheerleader for Big Data, and the book is PACKED with rapturous predictions of the many ways that smartphones will revolutionize medicine and empower patients to direct their own healthcare. (He's much less forthright about reporting his conflicts of interest, which include advisory roles and entrepreneurship interests in companies as varied as AT&T, Google, Walgreens, Illumina, and more, all of which are buried in the acknowledgements on page 292.)

Despite his insistence that he wants to democratize healthcare delivery, and wrest power from physicians to give it to patients, he has some rather peculiar blind spots about obstacles, especially as concerns the healthcare professions. Two are especially noteworthy. First, one of the main premises of the book is that doctors have pursued the art of medicine from an elitist standpoint, and have infantilized patients for far too long. I take his point, but I'm curious about why he portrays doctors as such a heterogeneous group. He ignores the effects of specialization on market segmentation, how doctors from different specialties interact with their patients, and how they deliberate among themselves (as specialists) to determine the most effective course of treatment. Throughout the book, he seems to assume that medical innovation is a straight-line prospect from collecting patient data, to mining that data, to creating algorithms that will allow patients to diagnose and treat themselves. It's that third step that is so contentious, I think, and which he oversimplifies. There are now many different governing bodies that generate evidence-based recommendations (some of them come from governmental bodies such as the US Preventive Services Task Force, while others come from professional societies). Topol doesn't give any insight into how he thinks these intra-professional struggles will play out in selecting the algorithm that will be built into these smart health care data systems. There is a possibility that he thinks it will all arise from the data itself, and will be filtered and refined from N of 1 studies via Bayesian analysis, without any need for interpretation or contextualization by physicians. I think it's more probable that smart health systems will (at least in the near term) continue to incorporate clinical decision support tools based on expert panel recommendations ... and as long as that is true, the conflict among doctors from different specialities will continue to be an obstacle in the road to medical progress, at least as he envisions it.

Second, the book is just thoroughly and curiously doctor-centric. He only rarely mentions other healthcare professionals (there's a brief discussion about how nurse practitioners and physician assistants could fill some of the demand for primary care), but he largely ignores other types of providers, and the many types of emotional support they provide to patients. I also believe that he overlooks some cohort effects. He presumes that millennial and "digital native" generations will jump on this bandwagon without any hesitancy, but I suspect that there are many older Americans who will still want to be able to talk through healthcare decision making with a caring healthcare professional. He's ignoring a considerable body of literature on shared decision making.

Finally, he really soft-pedals (to put it very mildly) health inequalities in America, or in international health. There's a very short section at the end of the book where he brings it up, but only in the context of the digital divide. Again, he presumes that once everyone is holding a smartphone and has access to broadband, all will be well. He completely ignores the many other social determinants of health (race, poverty, educational attainment, housing stability, job security) that currently burden many communities. These same inequities work on a global scale--as Paul Farmer commented about the Ebola epidemic last year, developing nations need three things: staff, stuff, and systems to cope with a public health crisis. Topol seems to think global health disparities will be solved simply by dispatching some nurses with smartphones, labs-on-a-chip, and some 3D printed devices to the developing world.

It's a fast read, and interesting to get a window into how the people who have drunk the Kool-Aid really think about these things. I may assign the chapter on cost controls to my undergrads.

[Megz · Rating 4 out of 5]

This is an excerpted review. For the full review, click here: https://barefootmeds.wordpress.com/20...

To be honest, when I requested this book I saw one sentence, “Computers will replace physicians in many tasks” and my vision went red. So my intention was kind of to read it and rip it to shreds.

Spoiler alert: I’m not going to rip it to shreds.

The Patient Will See You Now is essentially a massive meta-analysis of digitalisation and the subsequent democratisation of medicine. Every chapter is prefaced by apt quotes from others in the field, and Topol references some absolutely incredible academic papers. Essentially you’re not just reading a book, you’re reading a conglomerate of the best publications and scientists on the topic. (He also references House, M.D., so that is cool.)

“Once the digitisation of medicine got legs, it became increasingly clear that democratisation would be the next step.”

Topol calls the smartphone medicine’s Gutenberg Moment – put simply, that it promises to do for medicine and health what the Gutenberg Press did for humanity. This in itself is a fascinating analysis.

Topol also address important current matters of healthcare: such as the fact that many patients are not granted access to their own medical notes, one of the biggest paternalistic faux pas which persists in “modern” medicine.

This is not one of those hoi polloi books that claims that physicians all have evil intentions and that patients must take over. He takes a while to get there, but Topol acknowledges the value of the physician and actually impresses how technology can change our practice for the better.

Topol obviously has a bias, but he does a good job of presenting counterarguments to his own beliefs, and readily admits where more development is necessary. It makes the book realistic and worthy of acclaim.

[V · Rating 5 out of 5]

I was recommended this book by a lecturer of mine sometime last year and I only just managed to pick it up now. I wish I had read it even sooner because Eric Topol writes incredibly well and brings up so many really interesting and valuable points about medical paternalism and the future of healthcare and it is definitely something I will continue to think about as someone who is currently working and intends to continue working in the healthcare system.

5/5 stars

[L.C. Tang · Rating 3 out of 5]

This book arrived as a gift in my hands. This book is a bit dated but some points are still relevant. It is broken down into 3 sections and all the reviews in the front of the book speak well of this publication so I thought to give it some of my time. The author opens chapter 1 with reference to the American TV show called Seinfeld and the character Elaine being a difficult patient. This book is written from the perspective of the American health system and therefore not entirely relevant to an international audience. Topol has some good points and overall one should be proactive about one's own health. I found the writing to be a tad bland; the font size and colour of the paper made for an uncomfortable read for the eyes. I do like how the author included several quotes at the beginning of each chapter.

[Jayne Caron · Rating 1 out of 5]

Obviously the book is quite out-dated and he proved to be wildly inaccurate- especially regarding successful blood testing. However I think what's most disturbing is the alternate reality he seems to live in when it comes to patient autonomy and the role of the physician in the patient-physician relationship. Not every patient is as health literate as his favorite examples and he makes little to no case for doctors and genetic counselors and the important role they play in continually updating patients on med literature. I find this book to be almost unreadable given his huge bias for technology.

[Marcia · Rating 5 out of 5]

Anybody that ever plans to go see another doctor should read this book major changes are coming to the medical world and it means better things for us the patient

[Timo Hagmaier · Rating 4 out of 5]

Sehr umfassende, gut recherchierte und überzeugende Vision des Gesundheitswesens der Zukunft. Jede_r Mediziner_in sollte sich, wenn nicht mit diesem Buch, zumindest mit diesem Thema umfassend (eigentlich verpflichtend) beschäftigen.
Die Darstellung des Ganzen ist, wie oft bei Sachbüchern mit einer Agenda etwas optimistisch ausgefallen und vor allem in Deutschland (in USA vielleicht weniger) wichtige Themen des Datenschutzes und -sicherheit werden nur kurz behandelt. Jedoch werden die Möglichkeiten, die sich aus einer/dieser wohl unvermeidlichen Umstrukturierung ergeben würden, überaus glaubhaft dargestellt.
Eric verführt den_die Leser_in in eine traumhafte Vision, in der die Menschheit zusammen eine gesündere Zukunft für jede_n einzelne_n schafft, Krankheiten meist schon bevor sie entstehen verhindert werden können, und man als Patient_in im Mittelpunkt des Gesundheitswesens steht (und nicht der gottgleiche Doktor).
Erste Hälfte nimmt einen sehr stark mit, zweite Hälfte ist dann etwas schwächer, aufgrund weniger ansehnlicher Beispiele und vielen Wiederholungen.
Kanns jedem_r empfehlen, und Menschen des Gesundheitswesens nur umso mehr! Ein wichtiges Buch!
Danke Eric
8/10 📖

[Cyndie Courtney · Rating 2 out of 5]

An important book about the future technology plays in helping patients take charge of their own medical care.

Think could have been even more powerful if it had two things: 1) more balanced treatment of its subject matter (it felt like the dangers of the technology were largely downplayed relative and its benefits generally lauded to their greatest potential) 2) it provided a teaser into this kind of technology instead of such an exhaustive overview.

We would get the point with less examples and might be easier to buy with a more balanced approach. Though as you can see below, I definitely found the book thought provoking.

As a veterinarian I have perhaps an interesting view into the medical system, being both in it and outside of it since our clients are more free to choose who to see, how much care to agree to, and to choose not to seek care at all for their pets.

I agree that my patients benefit from access to information that doesn't always come directly from me and sometimes their ability to learn more or even just confirm what I have already told them can be quite helpful.

However, I have also seen it be quite dangerous and have seen people avoid medical care or self diagnose their pets improperly to great harm.

There truly IS a reason we team up with our patients, because sometimes a little medical knowledge can be more dangerous than no medical knowledge (thus data suggesting that many people use dangerous amounts of combinations of over the counter pain medications). Our clients bring the context of personal experience with themselves (or in my case their pet) to the table, and I can bring the broader context of medical knowledge and experience to the table.

Even in medicine it is vital that no medical professional is an island, patients should feel (as the book suggests) like they have a medical team who can work with them and work together to help see the whole picture and prevent medical errors. To have patients out there on their own making their own medical decisions, when even doctors should likely be making medical decisions in teams is worrisome.

I do agree that overall more access to our own medical records and the ability to potentially do something with them would give us a reason to improve our medical literacy. That ultimately should be good for everyone. I agree that challenging established medical theory can sometimes be a good thing (look at the early days of variolation, many doctors thought it was a bad idea), but it can be hard to know when it will be productive and when it will be harmful (snake oil medicines).

Even if patients don't feel anxious, confused or distressed by their medical information or making choices, they might still be lead down dangerous paths. Finding out what is genuinely worthwhile and what is exploitive is hard enough Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine will this just open the door for even more exploitation?

Overall a book based on interesting trends and thought provoking that I would have loved to see put together more concisely and with a bit more balance.

[Robert · Rating 4 out of 5]

Dr. Topol does a great job of laying out the current state of digital medicine, while arguing why patients need to become much more active participants in their care. Our healthcare system is very complex, and many treatments are also becoming more complex. While it would be brilliant to see a revolution in coordinated care, no patient should hold their breath waiting for it.

I was a little disappointed with Section 1, which alternated between breathless over enthusiasm for technology solving most problems and basic overviews of recent to not so recent developments in healthcare. If you stay relatively up to date on healthcare technology, you could skip that section without missing out on much. Fortunately, the other two sections of the book were much more interesting. Topol's breadth and depth of knowledge is impressive.

Given my work on healthcare pricing transparency at Castlight Health, the My Costs chapter was of particular interest (Castlight is mentioned several times). Topol did a very good of explaining pricing as it relates to the chargemaster, Medicare, Medicaid, and private insurance. I've analyzed the data CMS released on Medicare reimbursement versus what providers bill, and can confirm that quite a few hospitals will bill at 10x what they are reimbursed by Medicare. Supply and demand is a major factor in billed amounts, as I found the largest variance in areas with the least competition.

[Gaurav Andhansare · Rating 4 out of 5]

As technology integrates itself with every aspect of our life, it is important to consider the implications of its interaction with what unfortunately remains one of our most primitive aspects of our lives: health and medicine.
Dr. Topol describes the paternalistic side of medicine and its practitioners, its reasons and why it is increasingly irrelevant in today's world where many patients are googling symptoms for a provisional diagnoses and asking doctors to confirm it compared to a typical physician visit.
The healthcare machinery, due to its moral high position in the whole system uptil now has to catch up not only to the patients armed with raw data (at the very least) but also upgrade the way they practice and administer healthcare delivery.

The author touches upon some interesting points about ownership of the gazillion bytes of data generated by us, its collective power to advance sci-fi worthy fields of genetics and lab-on-a-chip tech to better health outcomes without spending billions of dollars in funding or tax payer money.

Although a long journey it is in terms of transparency vs. privacy, in any field let alone something as personal & private as health, we still need to address the issues and see how much we can utilize the tech wave.

The book makes for a brisk read, with ample side reads and charts/diagrams describing intriguing devices used in most remote parts of the world enabling modern day healthcare at more than reasonable costs.

[James · Rating 5 out of 5]

Great insight into what we as patients should be doing to better our outcomes. Fantastic insight into millisieverts and how to measure your cancer causing risks (see below).

The remote monitoring, the destruction of the need for more hospital beds and how to reduce costs were some good arguments presented. Lab on a chip or in the blood are excellent concepts. Also like the ways being presented to monitor if patients are taking their meds.

BEST PART of the book is the discussion of millisieverts. I had no clue what these were nor how they had any impact on an individual. It's amazing that the simple things we have done in life, the scans, the xrays, etc etc etc can lead to cancer. It's also make you think that you should challenge your doctor to look for alternate ways to examine, or for scans with less millisieverts if you want to lessen your chance of cancer.

Summarizing what I heard: You have a smaller chance of getting cancer if you keep your millisieverts exposure under 100. Let's say you go for a nuclear test (that's 40); how about a x-rays, that's ## a piece. Now think instead of the x-ray, you ask for an ultrasound; that saves you ## millisieverts towards your 100. This doesn't mean everyone keeping their score under 100 won't get cancer, but it's in interesting cause to at least be aware of.

[Tim Jin · Rating 1 out of 5]

Dr. Eric Topol had other motives besides being a MD when he was writing "The Patient Will See You Now." If it was up to Dr. Topol, he wouldn't see any of his patients in person at all. I wasn't too impress with his book. It felt like a scare tactic. If you have a phobia on your health, don't read it.

It you do a search on Eric Topol, the search result may surprise you. He is known for his digital medicine rather than his cardiology practice. His book is all about wireless and having your medical data with you wherever you are on your smart phone. The book reads like a tech blog than medicine. After half way through the book, you can tell that Dr. Topol has an invested interest for wireless medicine to succeed.

Like a pharmaceutical companies giving doctors kick backs in order to push their samples to patients, Topol is being bought out by wireless and tech. He credits all of them throughout the book. I'm not saying that the subject matter is bad, but the way that it is being presented to the reader is not neutral. Dr. Topol keeps pounding the same thing over and over, where I thought that I was reading something on Engadget. Too much tech and not enough doctor and patient.

[Mahesh Sharma · Rating 4 out of 5]

This is one of the books which should be a core reading in the syllabus of ‘Medical Humanities’, very relevant for the post-pandemic world.

[Trey Malone · Rating 2 out of 5]

My criticisms of the book is less about content and more about tone. Topol frames his book as an attack on the "paternalist" "elites" of medicine, but I think his criticisms are somewhat misguided. Instead of convincing me that doctors are elitist to a fault, Topol's content would made a more convincing case for optimism in the future of medicine.

It seems to me that the first few chapters should have been restructured as an optimistic look at patient-based solutions to health issues via individualized technology. From that position, he could have easily made a compelling case for the benefits of a minimalist FDA. Instead, he sets the book up to be easily refuted by pointing out the systemic irrationality of American patients (i.e. availability bias, pessimism, over-estimates of low-probability events, etc.).

[Daniel · Rating 5 out of 5]

This ground breaking book opens my eyes to the latest technological advances in the field of medicine, and I'm a doctor... It's amazing and surely patient empowerment (emancipation is the word the author used) is already happening and soon the relationship between doctors and patients will be changed forever. The only thing I don't agree is that the author thinks that hospitals will disappear, replaced by home monitoring... But who is going to help the patient if things happen? Nonetheless this is a great book!

[Daniel Barenboim · Rating 2 out of 5]

This book is basically a treatise on how healthcare should be improved and some of the ways that people have accomplished more by learning about health themselves instead of trusting their doctor. While I wholeheartedly agree with what this book says and have already put these principles into effect before reading it, I feel as though it is nothing more than a teaser. If we can not change the system, what's the use in talking about all of it's defects?
I can only sit here and ponder what to do with this knowledge.

[Stephanie Weaver · Rating 3 out of 5]

The overall content and focus of this book is terrific: empowering patients to own their own medical data, and painting a picture of both the positives and negatives of the impact of the Internet of Things on medicine.

It's a dense read, and it wasn't clear to me who the audience was. It's too detailed and high-level for the average patient, and doesn't have a clear enough call to action for physicians or legislators, which is why I gave it 3 stars.

[Hakan Jackson · Rating 4 out of 5]

From the title you'd think this book was all about how medicine will be practiced in the future. However, the book also delves into the past and how medicine got to where it is today. If you've ever experienced frustration with the medical system and are curious on how it'll change. This book is for you.

[Jeff LeBrun · Rating 1 out of 5]

This is basically a list of all the technological stuff that Topol thinks is cool. It reads a bit like an infomercial without much original or creative thought by the author. Some weird tangents where he describes something completely unrelated, like the development of the printing press, pad it up to novel-length.

[Debra Brunk · Rating 2 out of 5]

I was really looking forward to reading this book as I liked the premise. The first couple of chapters were very interesting and I learned a lot. However, the author should have stopped while he was ahead. From Chapter 9 on, the book seems to lose focus and becomes more about what the author knows than what the patient may want to hear (or read).

[Kathy · Rating 1 out of 5]

An interesting concept behind this book however, couldn't finish it. Not a fan of the author's style of writing and thought his perspective of doctor paternalism was too intense. Could not support this undercurrent view that was frequently mentioned throughout the first chapters I managed to get through.

[Blake Charlton · Rating 3 out of 5]

i'm with the author in spirit about using technology to making care more patient-centered, but the there are simply too many unsubstantiated claims and extrapolations without hard clinical data to make this convincing.

[Hussam Al Husseini · Rating 1 out of 5]

I was really excited to read the book but it is very boring and it feels like the author made a huge effort to increase the contents in details without any meaning. I read around 170 pages and could not continue!

[Thethingsiread · Rating 3 out of 5]

Book is too long for it s content
Gets repetitive
Author is more a Doctor than a technical person and lacks some background
Heavily US focused
His dream of a better future, but not really actionable

[Teresa Krum · Rating 4 out of 5]

I enjoyed learning about all the amazing digital developments that would greatly enhance patient knowledge. Early in the book it was demonstrated that increased knowledge by the patient was a powerful catalyst for change in behavior… and subsequent improved health. This is a piece of the healthcare puzzle that is long overdue!

Having operated a rural international “bush” clinic, I was most excited about the implications of the discoveries shared in the chapter, “Flattening the Earth”. At the time of this reading, this book is 10 years old, so I would love to know what has transpired since this book was first published.

[Marks54 · Rating 4 out of 5]

This book is a follow-up to the author’s book on “The Creative Destruction of Medicine”. As with the earlier book, the author presents a tour of "Medicine" today with a focus on how the provision of health care and related services from health sciences (pharma and devices) are being influenced by the advent of digital technology - taken to include both digital developments in information technology as well as the reconfiguration of medical knowledge and practice around genomics, genetics, and related fields. The additional focus of this book is on the personalization and democratization of health care as a result of the Internet, personal smartphone devices, the growth of “big data” analytic approaches, and changes in norms in medicine and elsewhere supportive of more open approaches to health care services. The author is an accomplished cardiologist and an active researcher who is very knowledgeable about the developments in health informatics covered in the book, including the business environment of health entrepreneurs and big time academic research institutions. The book is well written and generally does a good job of translating some heavy technical materials into terms that readers have a better chance of understanding - although this will be rough sledding for some..

The book is uneven but on the whole is very effective. I am convinced that technological change is radically altering the organization and practice of medicine, that these changes are becoming more pronounced and influential with the passage of time, and that these changes may lead to "better" health care. So far, so good.

The book has limitations, however. As with Topel’s earlier book, the tone and presentation concerns how the new world of healthcare is different from the old, and by implication much better. Anyone who has read the current popular landscape on the Internet, e-business, the growth of genomics, and the wonders of “big data” will be one familiar terms in this book. The problem is one of separating out the hype and wonder at all the newness from the fundamental changes with which we all must come to terms. What do we do? How do we best make use of this new world of democratic medicine? The book is also not a reference book but a set of perspectives. Topol is very readable and credible, but it is likely the case that one’s particular health needs will only partially line up with the contents of this book. If you find yourself with a funky gene pattern, you will be the one that must figure it out. The book will at best point you in a general direction. For example, it makes clear that consulting older more experienced doctors may not be the best course of action, as opposed to finding out where the research directions are going. Even so, it will be up to the reader to access the medical sources and figure out how to read and interpret the research work – which is never simple.


A point of perspective that is worth noting concerns the emphasis of Topel's book on individualized rather than general population based medicine. The idea is that we should be looking towards a future where everyone's unique situation (really unique because of the complexity of individual genomes) as distinguished from a one size fits all approach. This approach makes very good sense in medicine but the individual versus global perspective is analogous to the distinction in technology between the basic Internet on the one hand and localized information networks facilitated by GPS positioning data on the other. Balancing the demands of global and at the same time highly localized health information is a difficult task and this book improves on the first volume by discussing it more, although the surface of these issues is only scratched.

As with the earlier book, the case is not made here that these developments are leading to better health care for most of us. In addition, the argument here is one focusing on the primacy of technological change. I am increasingly dubious of such claims anywhere and particularly in medicine. Even if one fully grants the force of the technological wave, it may still be the case that many of our health care dilemmas are not inherently technological at all, but instead include politics, economics, and institutional change. Topol is aware of this but does not give it sufficient emphasis. For example, much time is spent on how to produce electronic heath records systems and the benefits such systems can bring. However, one of the biggest problems working against the development of a technologically superior uniform records system is that hospitals still need to maintain parallel records to comply with state and Federal requirements, which makes the resulting records systems remain complex and non-integrated, even if we possess the technological capacity to change records for the better. Will technology win out here? Perhaps, but I am not holding my breath.

Overall, while the book overstates its case, it is still well done, informative, and worth the time.

[Travis · Rating 4 out of 5]

This book was a hodgepodge of important/interesting topics, many of which I agreed with wholeheartedly (though some I had mixed feelings about). A selection of topics:

- We (i.e., doctors and patients) need to start leveraging personalized genomic information, to better spot genetic diseases, know about adverse drug interactions in advance, etc. Also, the FDA made some bad decisions about regulating straight-to-consumer genetic testing [agree!! Other great books on this topic are The $1,000 Genome by Davies, and The Language of Life by NIH director Collins]

- We should all own, and automatically have access to, our own medical records (lab tests, scans, notes from doctor visits, etc), as a basic right and also to streamline the system, cut down on repeat testing, etc. [agree!]

- Medical procedures/care in the US is too expensive; there should be more openness and standardization when it comes to medical costs [makes sense, though this is a prominent, complex topic, and I have less confident opinions about how to overhaul our pretty-broken medical system]

- Using existing and soon-to-come technology (smartphones, apps, connected sensors, "internet of things," etc), each patient will soon be able to generate a deluge of data about themselves and their health; we need to get better at managing this wealth of data, auto-interpreting it, and putting it in the hands of the individual in a way that enables them to be engaged in their own health. [totally agree -- for those aware of "active learning" strategies in the classroom, its the same idea: rather than having a "sage(/professor/doctor) on the stage" do *all* the deep thinking and interpretation and pronouncing the answer, the student/patient benefits immensely by being engaged in the data analysis and taking charge of their own health/learning -- of course, without fully abandoning verification/guidance by the "sage." Interestingly, the objections from both "sages" ("they won't be able to figure it out on their own!") seem similarly unfounded, and in fact often demonstrably false in practice.]

- Social media allows patients with rare conditions or specific to connect with other sufferers and compare experiences, treatments, etc [sure, though this can lead to rabbit trails, bad advice, hypochondriacs, etc]

- One of the topics he returned to frequently throughout the book, and which I have the most mixed feelings about, is the idea of paternalism in medicine -- the idea that "doctor knows best," and the problem that doctors are sometimes unreceptive/uninformative/uncommunicative/unfriendly/rude/out-of-touch/etc when it comes to discussing and weighing options, respecting the patient as a "partner" in managing their health, etc. I mostly agree (he provided, and we've all heard, horror stories about doctors who won't listen, miss important warning signs, etc), though I don't think he addressed that, often, the doctor actually *does* know best! He didn't address at all the problem of antivaccination, homeopathy, etc, that are blatantly wrong, yet the patient might feel strongly in favor of. How to deter patients from this, if not a paternalistic pronouncement (or enrolling the patient in a whole series of college science courses?).

I do think one of the most beneficial ways to get patients engaged in a productive way is to have them collecting objective, quantitative data about their own health [blood pressure, glucose levels, heart rate, temperature, asthma attack frequency, etc etc], so that they can have evidence-based conversations with their doctor. With the proper data (not just anectodal recollections), it could become clear that a certain medication is wearing off by the end of the day, or that a particular exercise habit often triggers asthma attacks, or that a certain strategy/drug isn't working for cholesterol, etc etc. This data is valuable for both the doctor (less guessing) and the patient (more engaged in own health).

- A final important topic was the idea that, for the good of everyone, yet without violating privacy, we need to collect all this data (genomic, physiological, environmental, pharmacological, etc) from large numbers of people, and get better at analyzing it, cross-referencing it, etc. By amassing a database of multi-variate information, we have an incredible opportunity to identify *personalized*, evidence-based solutions for various health problems in a way we never have before.

This is definitely the longest review I've written -- mostly for my own reference later. ;) In the end, I'm not 100% convinced by *all* of his arguments, and it seemed more disjointed than it could have (and perhaps a bit too broad?). Overall a great, thought-provoking read.

[Kevin Browne]

Eric Topol's newest book provides a thorough overview of many of the recent advancements in health care delivery which will surely cause massive disruption in the way health care is administered in the U.S.

Reading the book inspires me to make some connections to other areas which are, or soon will be, similarly disrupted. In particular, as an educator I see many parallels with the changes underway especially in higher education.

The same advances in technology will have some of the same effects on the institutions and those working in them whether they are physicians or professors.

Consider first the title of the book itself. In the not-so-distant future patients will have greater power over the relationship they have with health care providers. Slowly, the grip of medical paternalism will give way under the pressure of new low-cost technology. With so many other options for accessing health information and care, patients will benefit. And, many doctors will lose patients. Patients will have more choices and will demand that when they see their physician the experience be worth their time. For those physicians who aren't, the patient will certainly not see them.

If the patient gains more control over when and under what circumstances they will choose to see a doctor, that means only the best doctors will prosper. Only those willing to listen to their patients, really help them, address the root causes of their problems, and work to improve their overall health as opposed to simply managing symptoms.

To use Seth Godin's word, the physicians who will thrive in this environment will need to be "remarkable." Many physicians are not. What will happen to them? They will, and should be, disrupted right out of practice. So much the better for their patients.

As Topol points out in the book, we now have the technology to perform many parts of the routine physical via a patient's smartphone. The movement towards greater patient control will also include a shift from health care providers controlling patient data to patients taking ownership of their data. The patient will be able to monitor their own health stats, control their own data, test results, and other important information. Of course, that will mean more patient responsibility as well.

Needless to say, many health care providers will fight these changes because they ultimately mean the end of paternalism and many lucrative careers. And, as in other industries which are being disrupted like education, many will remain in denial about the coming changes in health care. Others will be slow to see the trend and get out in front of it. That will mean a lot of needless disruption to patients as practices scramble to keep up or stay afloat.

I would love to see those in the health care industry working to move these changes forward and adapt to them in ways that will benefit patients. Stop spending your time defending the status quo and start asking what you can do to improve patient care and patient health. Take the initiative to offer patients control over the medical records and test results. Find ways to work around needless bureaucratic impediments that will ultimately be overcome and streamline the patient experience.

There will always be a need for patients to see physicians in person at least for some health care needs. So, health care providers need to work to make these visits remarkable. Start with the presumption that you owe the patient their FULL visit time. Listen and find ways to document without sacrificing this listening time. Commit to seeing every patient, on time, every time. You think that can't be done? Ask why you think this and make the changes necessary to make this happen. Patients used to have to put up with this. Not for much longer. The patient will see you now, but only if you merit being seen. With so many other options available for their health care you will only be chosen if you do what most are unwilling to do. Be available. Be a resource for patient health. Be a partner in the patient's overall goal of good health. Do more than a smartphone app can do otherwise you will be replaced by that app.