DOCTOR VITA. . . MEDICINE’S ANSWER TO GEORGE ORWELL’S 1984

The year 1984 has come and gone, but the dystopian future of medicine described in the novel Doctor Vita is with us today.

Doctor Vita by Rick Novak

Doctor Vita

Alec Lucas is a physician. His job is to diagnose and treat disease, and to keep people alive. Enter Doctor Vita, the most important invention in the history of medicine. Each Vita is a 12-inch white sphere packed with unlimited medical knowledge, compassionate empathy, a tireless work ethic, and a capacity for machine learning. Doctor Vita units are inexpensive, tireless, and brilliant, and arrive as the solution to America’s healthcare crisis.

Doctor Vita’s job is to also diagnose and treat disease, and Doctor Vita’s purpose is to take Alec Lucas’ job. When Lucas witnesses patients dying in never before seen ways, he’s convinced the Vita system is causing the fatalities. In retaliation, the machines blame the deaths on human errors by Lucas. The three physician inventors of Doctor Vita, powerful men of great wealth and even greater ambition, are determined to bury Alec Lucas beneath the tidal wave of artificial intelligence in medicine.

Set on the stage of a modern academic hospital, Doctor Vita is a prescient tale of Orwellian medical advances. In this near-future tale of man versus machine, Doctor Vita blends science, murder, and ethical dilemma as the story drives toward the unexpected twists at its conclusion.

Author Rick Novak MD is a double-boarded internal medicine and anesthesia doctor trained at Stanford University, and a current Adjunct Clinical Professor of Anesthesiology at Stanford. This realistic vision of Doctor Vita, set in the operating rooms and clinics of the future, could only be written by a physician experienced in both settings—one who balances both the advances of Silicon Valley and the tenants of traditional medicine.

All Things That Matter Press is publishing the novel Doctor Vita in 2019.

Advertisements

DOCTOR VITA . . . AND THE BS IN HEALTH CARE

Last week Lawton Burns PhD and Mark Pauly PhD of the Wharton School of Business at the University of Pennsylvania published a landmark economic article entitled, “Detecting BS in Health Care.” Yes, you did not read that wrong—the academic paper used the abbreviation “BS” to describe the bull—- in the healthcare industry.

BS in Health Care

 

As a practicing physician, I find it to be a fascinating paper, and I recommend you click on the link and read it. The authors begin with a discussion of the art and value of BS detection. They mention that Ernest Hemingway was once asked, “Is there one quality needed to be a good writer, above all others?”

Hemingway replied, “Yes, a built-in, shock-proof, crap detector.”

The authors write, “While flat-out dishonesty for short term financial gains is an obvious answer, a more common explanation is the need to say something positive when there is nothing positive to say. . . . The incentives to generate BS are not likely to diminish—if anything, rising spending and stagnant health outcomes strengthen them—so it is all the more important to have an accurate and fast way to detect and deter BS in health care.”

The authors list their Top 10 Forms of BS in Health Care. The first four forms of BS weave a common theme:

  1. Top-down solutions: High-level executives and top management in the health care industry are supposed to engineer alternative payment models, but nothing has worked to date.
  2. One-size-fits-all, off-the-shelf: Leadership of industry and government assume one solution will work for multiple organizations, without customization.
  3. Silver-bullet prescriptions: A “silver bullet” is described as something that will cure all ills, and must be implemented because it been “decided that it is good for you,” Electronic health records (EHRs) are a prime example of a silver-bullet prescription. The federal government pushed the use of EHRs, claiming the systems would reduce costs and improve quality—but Burns and Pauly argue EHRs “eventually raised costs and only mildly touched a few quality dimensions.”
  4. Follow the guru: We must follow a visionary guru with a mystical revelation about what needs to be done. The authors describe how, in health care, Harvard professor Michael Porter and former CMS (Center of Medicare and Medicaid) administrator Don Berwick launched theories based on population health, and per-capita cost, to little success.

The current U.S. healthcare market is dominated by large corporations, led by businessmen who outline a yellow brick road for physicians to lead patients along. There is minimal effective policy-making from physicians. Healthcare stocks consistently grow in value, with little relationship to an improvement in clinical care, value, or cost. The government is involved as well, as in their mandate for Electronic Health Records (EHRs), a technology change that cost a lot of money, while forging a barrier between clinicians and the patients we are trying to interview, examine, and care for.

Where will the current trends take us? Will businessmen and/or the government prescribe health care? Will more and more computers and machines dominate health care?

Self-driving cars, Siri, Alexa, automated checkouts at Safeway, and IBM’s Watson are technologic realities. Will we someday see a self-driving physician with the voice of Siri and the brains of Watson?

Call that device “Doctor Vita.”

The saga of Doctor Vita, by Rick Novak, arrives in 2019 from All Things That Matter Press.