The Changing Role of Physicians: From Knowledge Brokers to Empathetic Healers | Deloitte US has been saved
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By Neal Batra, principal and Kulleni Gebreyes, M.D., principal, Deloitte Consulting LLP
Shortly before the COVID-19 pandemic, we met with executives at a health plan that serves a vulnerable population. We explained our perspective that by arming their members with the right tools and guidance, they can become empowered to make many health decisions without guidance from a physician. This line of thinking was met with some skepticism…particularly from one physician who was in the room.
Physicians have historically been seen as knowledge brokers who possess a wealth of information that they’ve accrued over the years—through medical school, experience with patients, medical journals, and collaboration with other physicians. They access and synthesize all of this knowledge to help patients understand the complexities of various diagnoses and treatments.
But the idea that the physician knows the patient best is an outdated concept. Consumers make hundreds of choices every day—from easy ones to extremely challenging ones. Low-income consumers have to make many of the same choices, along with other difficult decisions, and they typically have limited resources with which to make those choices. We believe that all people—regardless of economic status—can make the right health choices if barriers are removed and they are given the proper tools and guidance.
We believe in a future where physicians aren’t gatekeepers or prescription-writers as they are today. Instead, we expect they will be educators, data researchers, informatics specialists, digital consultants, and proceduralists. They might also be complex-care managers who focus on complicated illnesses or injuries. Some of them might become business-to-business consultants who advise physicians who work directly with patients, particularly around difficult cases. Physicians who perform procedures will still be needed in the future, but we expect we will need fewer of them as supporting robotics, and emerging genetic and molecular treatments reduce the need for invasive surgeries.
Technology as the ideal knowledge broker and diagnostician
Technology has the potential to help patients navigate complex and sophisticated medical topics. Consumers who have access to extensive external databases and digital decision-making tools might be able to make routine diagnoses and treatment decisions with the same precision as a highly educated physician. A patient with a sore throat, for example, might use a $2 home test to confirm a strep infection. Getting an amoxicillin prescription, however, still requires the patient to schedule an appointment with a doctor, travel to the office, find a parking spot, and sit in a waiting room (often among coughing and sneezing patients). The doctor might use a nearly identical strep test to confirm the illness that the patient has diagnosed, write a prescription for the medicine the patient knows they need, and charge the patient’s health plan several hundred dollars for the service.
This outdated model has typically been driven by the belief physicians need to protect the individual from themselves and the care delivery system. But this system is inefficient and typically adds cost, rather than value, to the system. Anyone who sits between the patient and the services they procure could be removing value instead of creating it.
Moreover, many of the tasks physicians perform are repetitive and based largely on pattern recognition and a well-traveled treatment path. Automated systems could enhance and displace up to 80% of physicians’ current work1—freeing them from repetitive and data-management tasks (e.g., clinical documentation, coding for billing and quality reporting, and patient scheduling) so they can focus on direct patient care. As we move into the future of health, we expect physicians will continue to serve an important role, but the value proposition will be different than it is today.
From system guardians to empathetic healers
The volume-based model of health care has been highly lucrative. But this model has led to an assembly-line profession that thrives on volume and encourages unnecessary tests and interventions. This system of reinventing the wheel on a daily, physician-by-physician, and practice-to-practice level often leads to processes filled with unnecessary variation, wasted money, time, and resources, negative patient outcomes, and physician burnout.
Over the next five to 10 years, 65% of physicians expect it will be standard practice for consumers to own and control their health data, according to the Deloitte Center for Health Solutions’ Survey of US Physicians. Moreover, they estimate that 30% of their current work can be performed by nonphysicians and 18% can be automated.
We expect that physicians will spend less time making routine diagnoses, and more time interacting with patients who want a human touch, or who need guidance navigating a complex health condition. The physician then becomes an empathetic healer who guides the patient through the coldness of a technology-driven health care system, as described in Deloitte’s 2019 report, Shaping the Physician of the Future.
Tell Dr. Chatbot where it hurts
Many of the routine tasks performed by physicians don’t require any advanced critical thinking. Routine assembly-line care might be handled more effectively by technicians who are aided by artificial intelligence (AI), machine learning, and other technologies. Case in point: Early this year, Anthem, Inc., which operates Blues plans in five states, announced the launch of a co-branded AI-driven triage app with K Health, a New York-based technology firm. The tech tool uses a chatbot to interview patients about their conditions, medical history, and demographics. It then accesses databases to diagnose conditions and recommend a care path.2
Physicians do see some value in chatbots, according to a survey of 100 practicing US physicians.3 A majority of physicians agreed chatbots could be useful in scheduling appointments, helping patients locate clinics, or by providing medication information. However, most respondents (76%) noted that chatbots have limitations. They cannot display human emotion and cannot provide detailed diagnosis and treatment because they don’t understand all of the personal factors associated with the patient. A majority of respondents also warned that chatbots could be a risk to patients if they make inaccurate diagnoses or if the patient doesn’t fully understand the diagnosis. We agree that human interaction does provide a level of comfort, but a machine—underpinned by AI and millions of instances of learning—could improve the accuracy of diagnoses and might help patients understand their condition.
The care-delivery system tends to see physicians as the sole conduits and arbiters of medical knowledge and insight. Incumbents have been pushing back against AI and other technologies for years. Fear of not including the physician in decision making can be seen as reckless. There are dire warnings that machines make errors. But let’s not forget that humans make errors, too.
More than 250,000 deaths per year are due to medical errors, which is a leading cause of death in the US.4 As a society, we have become comfortable with a certain level of risk, and businesses that benefit from the status quo perpetuate the comfort of the known risk as opposed to navigating through the unknown risk.
As AI becomes better than grey matter at diagnosing and recommending treatment regimens, we expect knowledge-broker physicians will take on more of an analytical consultant role in addition to being empathetic healers. This could make the human connection between patients and physicians even more important.
Technology-enabled physicians will likely have more time to investigate difficult medical conditions and have in-depth conversations with patients who need the most care. A physician’s ability to connect with patients, console them, and express emotion will likely become as important as the physician’s ability to diagnose and treat. Patients might value the emotional quotient (EQ) of their physicians as highly as they value their IQ.
Over the next 20 years, we expect that AI and other technologies will significantly enhance physician expertise and artistry, which could elevate the human experience even further.
1. 20 Percent Doctor Included” & Dr. Algorithm: Speculations and Musings of a Technology Optimist, Khosla Ventures, September 30, 2016
2. Consumers Will Be Able to Pay for Doctor Visits on Their Phones, Via Anthem, Wall Street Journal, July 22, 2019
3. Physicians’ Perceptions of Chatbots in Health Care: Cross-Sectional Web-Based Survey, the Journal of Medical Internet Research, April 5, 2019
4.Study suggests medical errors now third leading cause of death in the US, Johns Hopkins Medicine, May 3, 2016
Neal Batra is a principal in Deloitte’s Life Sciences and Health Care practice focused on business model and commercial operating model innovation, redesign, and transformation. He heads Deloitte’s Life Sciences Strategy & Analytics practice, leading the way on next-gen enterprise/functional evolution by connecting strategic choice with analytics and technology. Batra has more than 15 years of experience advising health care organizations across the ecosystem on critical strategic challenges, including leading businesses in biotech, medtech, health insurance, and retail health care. Batra is the coauthor of Deloitte’s provocative Future of health point-of-view, speculating on the health care ecosystem in 2040 and the business models and capabilities that will matter most. Batra lives in the Tribeca neighborhood in New York City. He holds an MBA from London Business School and a BBA from the College of William and Mary.