Imagine a world where the doctors we see today no longer exist. This is what Professor Pali Hungin, who heads up the the Changing Face of Medicine (CFM) project, is grappling with as rapid societal and technological developments outpace traditional medical training. Gone are the days of passive patients with low expectations; 20 years ago, for example, few of us would have imagined that we would be seeking health advice from mobile phone devices. Meanwhile, technology, artificial intelligence, and other new sciences, such as genomics, are altering medicine fast.
It’s why Hungin and his colleagues believe that medical education, practice, and the traditional role of the doctor needs a radical rethink. He and colleagues involved in the commission are busy re-imagining a possible vision of what clinicians and medical practice will look like in the next 20 years. “There is a thought that looking into the distant future, the doctor as a professional as trained today may not need to exist. So a person who is not well may see a diagnostician who needn’t necessarily be trained traditionally as a doctor,” says Hungin. “The diagnostician may be armed with AI and machine learning technology, and might be able to take the necessary steps.”
“And then if any interventions are required – and we know that for example, practical interventions like surgery are now advancing rapidly in terms of robotics and so on – so you could argue that the person who performs those interventions, again, need not necessarily be a traditionally trained doctor.”
The CFM project is less a case of turkeys voting for Christmas, and more an acute awareness that sociological and technological shifts have put doctors under severe strain. Far from dispensing prescriptions, the commission is seeking to encourage dialogue around how these challenges can best be met. Hungin believes the profession is in a transitional phase and heading towards a “completely different world”. Set up 18 months ago, it’s a collaboration hosted by the Academy of Medical Royal Colleges. The project has been funded by the Wesleyan Foundation and some initial monies from the British Medical Association.
The medical profession has always adapted to change, says Hungin, but it is being overtaken by certain developments that are leading to symptoms of “dissonance” such as disillusionment and burnout. Doctors, traditionally trained in a certain way, “have been struggling to find a role for ourselves in this new age,” he says. The old top-down doctor-patient relationship has not been valid for some while: patients are more informed about treatments, and have higher expectations. Traditional doctor-training, meanwhile, now seems to many out of step. High levels of work pressure mean that an increasing number of doctors do not want to work full time anymore. Overall, supply of staff working in medicine cannot meet current levels of demand.
Hungin cites a survey conducted last year by the Royal Medical Benevolent Fund, of which he is a trustee, which found that a high proportion of doctors would discourage their children from going into medicine. Why? Because they found it an unfulfilling, difficult and stressful career, he says. Therein lies the problem.
Hungin’s medical record dates back to the analogue world of 1970, when he arrived from Kenya to study medicine at Newcastle University, where he is now emeritus professor of general practice. He trained as a GP, later juggling the role with a range of academic endeavours. In 2016, he used his tenure as president of the British Medical Association to lead a year-long international project into the impact of the fast-changing environment on doctors’ sense of vocation, their professional values and their relationship with patients and the public.
He has continued this through the CFM commission, which has working groups looking atfive separate themes public-patient-doctor engagement; technology, informatics and AI; clinician wellbeing; rethinking medical education and leadership. Last week, around 80 people were invited to attend a CFM conference organised by Hungin to discuss how clinicians and medical practice will evolve. The chief medical officer for England, Professor Chris Whitty, was among those in attendance. A report will follow.
The health secretary, Matt Hancock, wants the NHS to be more tech-focused. Last summer, Boris Johnson announced £250m for the use of AI in the NHS. Hungin welcomes the funding, but says that this emphasis “might start to detract” from the importance of investing in the human element of healthcare. The greater the technological leaps, the greater the need for human contact to help people make sense of their difficulties, their diagnosis and their most appropriate course of action, the commission has found. Who provides that human contact is another matter.
Hungin doesn’t believe that doctors will become obsolete, but he does see “new roles” emerging that are neither the traditional model of a nurse or a doctor. They will be a “highly modified” version of the ones we recognise today. He also thinks we will have to manage with fewer of them.
“We know that the public and patients appreciate having someone else to have an interaction with, and we can’t replace that someone else with technology alone,” he says. “Whether that person needs to be a traditionally trained doctor is a reasonable question to ask. If your role is to operate on a particular part of the body, using highly specialised machinery and skills and techniques specific to that particular procedure, then do you have to go through all the traditional steps of medical training as we have now, plus the years of an apprenticeship-based model, in order to establish your competence?”
Yet youngsters who aspire to become doctors have no reason to feel downcast. Hungin insists that this is “the most exciting time of all” to train as a doctor, because genomics and the like will help patients receive highly personalised care.
Would he recommend the route to any future grandchildren? “Yes. Undoubtedly so,” he replies. “If I had the opportunity to retrain as a doctor now, I would grab it with both hands.”
Family: Married, three grown-up children.
Lives: Egglescliffe, Teesside
Education: Highway secondary school, Nairobi, Kenya; Newcastle University Medical School (MBBS and MD); Diploma of the Royal College of Obstetricians and Gynaecologists.
Career: 2018-present: lead, Changing Face of Medicine Commission, Academy of Medical Royal Colleges; 2017-18: professor of primary care and general practice, faculty of medical sciences, Newcastle University; 2016-17: president, British Medical Association; 2003-14: dean of medicine, Durham University; 2001-2005: chair, NHS Research and Development Forum, England; 1980-2014: general practitioner, Stockton-on-Tees; 1983-1996: hospital practitioner, James Cook university hospital, Middlesbrough.
Public life: 2008-present: deputy lieutenant, Co Durham; 2015-present: trustee and treasurer, Royal Medical Benevolent Fund; 2012-present: member, St John’s Durham County Priory Group; 2017-present: advisory board, Wesleyan Assurance Society; 2019-present: non-executive director, Tees, Esk and Wear Valleys Mental Health Foundation Trust 2019; 2003-present: fellow, Royal Society of Arts.
Awards: OBE 2000, John Fry Award and Pickles Medal, Royal College of General Practitioners; William Cullen Prize, Royal College of Physicians, Edinburgh.
Interests: Music, reading, cricket, classic car repairs.