The Future of Critical Care Medicine

Bertalan Meskó, MD, PhD, was six years old when he was introduced to science fiction. He read a scientific encyclopedia for children, then saw movies such as The Terminator and Back to the Future and was hooked. He was enthralled by what seemed like limitless possibilities, and he decided he wanted to pursue a career in science and ultimately become a doctor. He imagined all the advanced technologies like virtual reality and artificial intelligence (AI) that would exist by the time he went to medical school to help him learn to be a better doctor.
 
That vision did not become his reality. He made it to medical school but was forced to study three-dimensional topics in two-dimensional textbooks. It was not what he envisioned. Then about two years ago, Dr. Meskó finally met science fiction. He heard about a headset that used augmented reality to teach human anatomy. He tried it, and it became a defining moment in his life.
 
“A holographic image of a body appeared before me,” Dr. Meskó said. “It had a beating heart. I could dissect it without physical limitations—and without the formaldehyde smell. I could dissect just the bones, just the muscles. I could study anatomy like never before.”
 
Dr. Meskó shared that memory as part of his presentation “Future of Critical Care Medicine” at the Society of Critical Care Medicine’s 50th Congress. As director of The Medical Futurist Institute, Dr. Meskó explores what the future of medicine will look like. In his eyes, this connection between healthcare and science fiction matters.
 
Traditionally, healthcare has not been a field open to innovation, Dr. Meskó explained, often because physicians prefer to do things the way they have always done them, or because there is a fear of the unknown. But innovation is here, and it is critical for the medical field to embrace it, he said. To demonstrate this point, Dr. Meskó shared an illustration of a woman having her arm scanned with a portable ultrasound. Above her head is a screen broadcasting a physician on a feed. Beside her is a 3D printer. In the background is a drone dropping medical supplies. It looks like science fiction, Dr. Meskó said, but in reality, it captures healthcare innovation in Rwanda, a country on the cutting edge of adopting digital technology.¹
 
Technological innovations are developing at breakneck speeds, from watches that track a person’s heart rate and sleep patterns to genetic and microbiome testing. When Dr. Meskó considers healthcare’s future, though, technology is not his primary focus. The true innovation facing the industry is one built on what he calls the most underused resource in healthcare—patients.
 
“What has been going on in healthcare in the 21st century is not a technological revolution, but a cultural transformation,” he said. “While it was initiated by amazing technologies, at its core, healthcare has been going through a transition. The hierarchy of the physician-patient relationship is becoming a partnership; the role of the passive patient is transforming into a proactive, empowered patient; and the role of physicians is transforming from being the keyholders to the ivory tower of medicine into being the guides for their patients in the jungle of health and digital information.”
 
Dr. Meskó believes this cultural transformation will create an equal-level partnership between physicians and patients and ultimately a democratization of care. As patients are able to access more information about themselves, physicians should be ready to work with them to help understand and ultimately manage that data.
 
For example, Dr. Meskó has received results from six different DNA tests and through these discovered what medical conditions he might be at risk for and what medications he has a sensitivity to. If he becomes ill, he can bring that information to a physician as key data to consider as part of his diagnosis and treatment plan. “Patients will be able to do even more,” Dr. Meskó said, “and they would love to contribute because they have a lot to contribute to the medical decisions you make with them. This is the patient from the future.”
 
With this in mind, Dr. Meskó suggested that changes to healthcare organizations be made with the patient in mind. Patients should also feel empowered to have their voices heard. While the patient-caregiver relationship will change, so too will the tools available to healthcare professionals, and that starts with AI as a new member of the medical team. “It’s going to be your best assistant ever,” Dr. Meskó said. “You have to know about it, you have to acknowledge it and learn how to use it and work with it.”
 
Dr. Meskó and his team at the Medical Futurist Institute publish studies about the role AI will play in the future, analyze trends and the impact of automation on medical specialties, and explore what role AI can play in achieving precision medicine. Dr. Meskó believes AI will:²
 

• Create better-organized healthcare logistics
• Reduce the time it takes for an experimental drug to go from concept to market
• Improve working conditions for medical professionals while saving lives
• Find new associations between risks and diseases
• Reduce the time physicians spend on information technology and electronic health records
• Help forecast future disease outbreaks and pandemics
• Become unbeatable at specific, data-oriented tasks

 
Beyond advances in AI, augmented reality and machine learning will become valuable tools in a physician’s toolbox. “Augmented reality can help medical students prepare for delicate situations,” he said. “It can help them prepare for emergencies by putting them through the same scenarios dozens of times instead of living through one in real life. Machine learning can help physicians make better decisions by making sure to put all relevant information into their hands while dealing with their patients.”
 
There are limits to what these technologies can do. Technology will not solve every challenge clinicians face today, and it will not replace clinicians. What it can do is be a partner, and that’s where Dr. Meskó returns to his passion for science fiction. In his eyes, science fiction forces people to ask “What if?” more often. What if you could use a 3D printer to create customized medications for your patients? What if algorithms could be taught empathy? What if we become a multiplanetary species?
 
Some people may feel it is daydreaming to dedicate time to these types of questions, but Dr. Meskó considers it preparation. “In medical school, we are told to focus on problems today and try to solve them,” he said. “But one of the major elements of being a physician is anticipation, trying to find out what might happen next. This is a skill every physician has, but it can and should be upgraded by looking more into the future. Science fiction does this job while also entertaining us and challenging our mindset.
 
“By playing with the ‘What if?’ question, you gradually prepare yourself for whatever is coming next. It’s not about losing your profession or technology replacing you. It’s about you being augmented by new technologies while you are caring for your patients. I think that’s a vision worth fighting for.”
 
 
References

1. The Medical Futurist. Rwanda and the dreamers of digital health in Africa: Wakanda is real. August 29, 2018. Accessed January 28, 2021. https://medicalfuturist.com/digital-health-in-rwanda/
2. The Medical Futurist. 7 things you can expect from A.I. in healthcare. October 21, 2020. Accessed January 28, 2021. https://medicalfuturist.com/7-things-you-can-expect-from-a-i-in-healthcare