[Music]
[Applause]
so I don’t talk about it about the whole
evolution of the doctor-patient
relationship I’m a cancer specialist I’m
working for the best parts more than two
decades actually looking after patients
who unfortunately have a diagnosis of
cancer as part of the fliction which
causes lots of stress of course death
morbidity mortality my Germany of course
20 years is realizing what’s my role
myah purely a technician holding a knife
scalpel
offering operations when it’s
appropriate was it more than that what
about the communication takes place from
the whole subject of health so let’s
take here into a little story imagine
coming to my word for a moment or two on
Tuesday morning just gone I was in my
clinic at the Royal London Hospital a
stone’s throw away from this
establishment I said to my clinic with
my nurse specialist and my team looks
with the patients I’m going to see that
morning most of which have had a new
diagnosis confirmed or about to be
confirmed on that appointment make a few
decisions roughly what we’re going to
say to them how you manage the
expectation I then walk out of the room
into the corridor and I walk out into
the reception area where there’s just a
melee of people waiting for various
appointments in the hospital I then call
a name loudly
the next patient to be seen that’s my
first interaction with that patient
who’s about to get a diagnosis of cancer
they they get up and look into my eyes
my first interaction is the visual cue I
try to assess the original it will
restrain away what what’s the
expectation what we’re dealing with how
am I going to become some of their fears
and horrors that might come through the
diagnosis to be made that
so next thing I do they come I greet
them I shake their hand the first touch
of human behavior in a medicine look in
their eyes and say I’m chef Yama D
pleased to meet you come with me and
take a seat
so that’s the first connection I make
with the patient that’s got a new
diagnosis and then we bring them into
the room we sit them down and it’s
difficult now how to approach that
communication tool how do we connect
that person immediately how to reassure
them they’re in good hands how do we
assure them that they’ve got expertise
around them to look after them in this
difficult time
so normally I’ve asked them how are you
Taymor about yourself and they’ll start
talking about themselves hopefully to
start breaking the ice I then come down
to the problem I ask them do you know
why seeing me today to get insight to
find out what they understand about
their problems and most of my linking of
course before coming because that CT
scans MRI scans and Oscar peers people
aren’t stupid of course they know that
we investigating a problem then of
course we sit down and we break bad news
sometimes that the bad news can be good
it can be ways I can cure people with a
knife with an operation or turn to Lee
it might be chemotherapy radiotherapy
sometimes of course it’s palliation only
we have to break bad news that we can’t
really offer much treatment to their
condition often they may be upset they
may break down in front of us they may
start crying when they do that of course
the first instant that we have is that
we go for the tissue box we offer them a
tissue it’s sign of insecurity of my
part almost saying that I currently help
you but I can get a tissue for you at
least it’s automatic for us we then
often hold their hands support them what
touches on their shoulders
it’s going to be okay with the best that
we can for you so in that environment we
had met the patient we’ve met through
the eyes we’ve touched them they’ve hit
our voice we try to have soft tones in
our voice we then bring them in a break
bad news again hold them and hopefully
we can help them in that regard my
question to you now in this what I’m
going to give around evolving
relationship is how is it evolved over
thousands of years and now the
technology interface is it changing and
do we need to change the way we behave
do patients need to change the
expectations of what’s going to be
afforded at a consultation you see we
have a problem globally we don’t have
enough doctors we need more surgeons
around the world two million today we
need today just to make sure health
care’s my critical healthcare resources
aren’t sufficient all healthcare system
in the world are struggling those
resources how to make it more efficient
how to see many more patients can we
actually offer them the time that we’ve
been given in the past to break bad news
to teach to treat them talk by their
prognosis are we in a rush suddenly our
lies a one-click
Amazon one-click just eat of becoming a
one-click doctors are we suddenly
changing the paradigm of health care
when I qualified we all sat and took the
Hippocratic oath who was written three
to five thousand years ago probably as
the first doctors this was about our
role and our pledge to our patients
these are the declaration of Geneva
which has superseded the Hippocratic
oath this what I said – when I qualified
back in 93 we stood up we said these
words it still remains true today
but however it doesn’t say you can’t use
technology
it just says these are the parameters of
your relationship with your patient
which is obviously sacrosanct
so my question now is can we challenge
some of this visit
history already predicting our behavior
we’ve now got a plethora of telemedicine
devices you can now pick up a smart
phone and communicate I’ve made my phone
but what’s that you can stream live on
Facebook and social media
suddenly connections slide different and
the human interaction will change you
have to evolve because of the people
that we are and have technology going to
interface okay there’s about a 15-second
delay from what I talked to – from what
he tells me so bear with us it’s not ok
I’m just going to show me so I made the
consent form of the actual operation so
just bear with us just a minute
and essentially don’t know if you can
see this but his hemoglobin from
yesterday was 12 21 it’s white count is
10.5 his renal function is normal and
it’s 81 its CRP is a little bit up its
138 from 103 that’s because of that
pelvic connection is he booked a theatre
thank you he wishes you all the best and
he’ll see you tomorrow see you tomorrow
see you later
so this is my trainee wearing a Google
glass wearable technology streaming
through his points of view I want to
make a phone or a computer somewhere
else giving instructions by text message
which comes up in the glass saying this
is okay go ahead there’s a communication
there but I’m remote is that enough for
the patient to be thinking of the
consultant seeing him and managing his
condition or say I’m on holiday be like
me to be there for example but he’d
prefer that to somebody else it’s not
seeing him for forever there’s not his
patient for example so we’ve got to
think about how we
change the way we look after people
there’s a progress getting stronger
putting on weight I’ve gone back to work
part-time so Pamela how’d you feel about
me seeing you through a telepresence
system for example I’m right here in the
country I’m elsewhere I could just and
you come to my clinic how would you feel
do you think anything missing with a
human touch obviously we can you can see
somebody you can they can move around I
can hear their voice what about the
human touch important to me but
necessarily important it’s not necessary
but it’s nice could you cope without it
I mean the whole point is we in here
existence we think that’s important
because we created that situation that
we believe is necessary what do you
think
so the patients obviously have an
expectation an understanding of who we
are or what role that we have in that
situation what about our own colleagues
say I was the great operating theater
operates every week
what about how they communicate with me
if I wasn’t there
there you go for introductions Simon so
[Music]
looking for nice artists you’re sitting
with me on the iPad so that’s why
they’ll be confused because they have to
start the operation now they’re nice it
is that was interesting I just added
value the MDT I did my ward rounds and
and interests within about two to three
minutes the Sun becomes normalized
suddenly this machine contraption with
your face on which moves round a bit is
normality people to run ask these
questions they discuss things with you
as if you’re just there it’s incredible
that we just accept these things
changing very rapidly we need to ask the
question and to challenge the document
addition they associated with healthcare
technology of course there’s all this
there’s now art intelligence within the
next two to five years the first point
of contact will not be human being it’s
going to be AI in the background chat
BOTS other mechanisms of communicating
with people whether it’s non-human
whether it’s created by avatars so now
in parts of UK and parts of the globe
you can ask questions to a chat bot
there’s no human interface there’s no
touch there’s no eye sight it’s just
asking question after question and
algorithm based gives a diagnosis and
now it will say to you go and pay a
prescription from the chemistry be done
without ever seeing a doctor we’re gonna
used to this because this is the way we
maximize efficiency in healthcare around
the world because that chat bot could
treat millions of people in one go where
individually is much tougher so we’ve
got a global problem with lack of
resources lack of doctors so a is going
to change where you work remember the
next two to five years your first point
of contact will not be anything like me
it would just be an AI system work in
the background
we can go further what about if the AI
system becomes more realistic this is me
with a hundred four cameras creating
what’s called photogrammetry creating my
avatar a volumetric part of me what if
we add facial expression to that avatar
that’s my avatar and add human contact
and face to face expression smile the
eyes would change add voice with
interface in AI so you ask you a
question
it talks like me it acts like me it has
knowledge but much more knowledge
because I’m only confined to 22 years of
clinical practice this thing will have
knowledge across entire Google spectrum
much better than me so suddenly and that
could teach or treat
millions of people right soo expanding
healthcare you make it more efficient
and expanding and scaling up perhaps
that’s where we need to be in the future
next thing I’m going to do is an
intestine tech so we’ve had a few shoes
today
I’ll show you something that hasn’t been
trained before first time and I thought
I’d show you showcase it because TEDx is
about how we communicate in a virtual
space so give me one second and I’ll set
it up and let’s see if it works
bubbly so let’s play a video for you
which would demonstrate where I’m trying
to do a trial figured out as well as
this backbone of you know for all
example all three of us are in different
cities right now Harris and I are in
America and shoppi
they’re in London I believe we’re all
here together face to face in a noir and
we’re able to share that 3d content
whether it might be an MRI scan or
existing anatomical models and we might
be three doctors coming together able to
put our heads together face to face no
matter where we are in the world
communicate and collaborate and really
problem solve around that particular
patient and their needs
absolutely so that’s the kind of thing
we’re doing in fact I can see both in
and Harrison here with me right next to
me they’re talking to me at the moment
having conversation in the background
just similar to this so you can share
assets you can probably go ahead and
bring scans in and ultimately though we
can into be position in the future where
you may end up doing virtual reality
operations about feeding touch with
haptic loves and things in this whole
exciting space around augmented reality
virtuality mixed reality so message
really at the end of all this is the
fact that I can take soft note that
we’re going to change I think we need to
adopt different ways of managing our
patience and expectations we have to
involves human beings and I think part
of its parent psychosocial behavior what
expectations we have I’m gonna challenge
the way we’ve done things for many years
we will have a global problem of
shortage of doctors and nurses and we
also have a shortage of resources and to
improve the efficiency of our health
service and perhaps these are the kind
technologies that will help us empower
ourselves but also patients I was a
quick thank you to Pamela who’s on the
video that you saw who allowed me to
video there’s all my patients who really
support innovation who don’t mind being
shown in the world the stuff that I do
with surgery and training on the global
level but also sharing their stories
with people like yourselves and Pamela
is actually the audience today watching
this because I want to share that with
her that story thank you
[Music]
[Applause]
[Applause]
so I don’t talk about it about the whole
evolution of the doctor-patient
relationship I’m a cancer specialist I’m
working for the best parts more than two
decades actually looking after patients
who unfortunately have a diagnosis of
cancer as part of the fliction which
causes lots of stress of course death
morbidity mortality my Germany of course
20 years is realizing what’s my role
myah purely a technician holding a knife
scalpel
offering operations when it’s
appropriate was it more than that what
about the communication takes place from
the whole subject of health so let’s
take here into a little story imagine
coming to my word for a moment or two on
Tuesday morning just gone I was in my
clinic at the Royal London Hospital a
stone’s throw away from this
establishment I said to my clinic with
my nurse specialist and my team looks
with the patients I’m going to see that
morning most of which have had a new
diagnosis confirmed or about to be
confirmed on that appointment make a few
decisions roughly what we’re going to
say to them how you manage the
expectation I then walk out of the room
into the corridor and I walk out into
the reception area where there’s just a
melee of people waiting for various
appointments in the hospital I then call
a name loudly
the next patient to be seen that’s my
first interaction with that patient
who’s about to get a diagnosis of cancer
they they get up and look into my eyes
my first interaction is the visual cue I
try to assess the original it will
restrain away what what’s the
expectation what we’re dealing with how
am I going to become some of their fears
and horrors that might come through the
diagnosis to be made that
so next thing I do they come I greet
them I shake their hand the first touch
of human behavior in a medicine look in
their eyes and say I’m chef Yama D
pleased to meet you come with me and
take a seat
so that’s the first connection I make
with the patient that’s got a new
diagnosis and then we bring them into
the room we sit them down and it’s
difficult now how to approach that
communication tool how do we connect
that person immediately how to reassure
them they’re in good hands how do we
assure them that they’ve got expertise
around them to look after them in this
difficult time
so normally I’ve asked them how are you
Taymor about yourself and they’ll start
talking about themselves hopefully to
start breaking the ice I then come down
to the problem I ask them do you know
why seeing me today to get insight to
find out what they understand about
their problems and most of my linking of
course before coming because that CT
scans MRI scans and Oscar peers people
aren’t stupid of course they know that
we investigating a problem then of
course we sit down and we break bad news
sometimes that the bad news can be good
it can be ways I can cure people with a
knife with an operation or turn to Lee
it might be chemotherapy radiotherapy
sometimes of course it’s palliation only
we have to break bad news that we can’t
really offer much treatment to their
condition often they may be upset they
may break down in front of us they may
start crying when they do that of course
the first instant that we have is that
we go for the tissue box we offer them a
tissue it’s sign of insecurity of my
part almost saying that I currently help
you but I can get a tissue for you at
least it’s automatic for us we then
often hold their hands support them what
touches on their shoulders
it’s going to be okay with the best that
we can for you so in that environment we
had met the patient we’ve met through
the eyes we’ve touched them they’ve hit
our voice we try to have soft tones in
our voice we then bring them in a break
bad news again hold them and hopefully
we can help them in that regard my
question to you now in this what I’m
going to give around evolving
relationship is how is it evolved over
thousands of years and now the
technology interface is it changing and
do we need to change the way we behave
do patients need to change the
expectations of what’s going to be
afforded at a consultation you see we
have a problem globally we don’t have
enough doctors we need more surgeons
around the world two million today we
need today just to make sure health
care’s my critical healthcare resources
aren’t sufficient all healthcare system
in the world are struggling those
resources how to make it more efficient
how to see many more patients can we
actually offer them the time that we’ve
been given in the past to break bad news
to teach to treat them talk by their
prognosis are we in a rush suddenly our
lies a one-click
Amazon one-click just eat of becoming a
one-click doctors are we suddenly
changing the paradigm of health care
when I qualified we all sat and took the
Hippocratic oath who was written three
to five thousand years ago probably as
the first doctors this was about our
role and our pledge to our patients
these are the declaration of Geneva
which has superseded the Hippocratic
oath this what I said – when I qualified
back in 93 we stood up we said these
words it still remains true today
but however it doesn’t say you can’t use
technology
it just says these are the parameters of
your relationship with your patient
which is obviously sacrosanct
so my question now is can we challenge
some of this visit
history already predicting our behavior
we’ve now got a plethora of telemedicine
devices you can now pick up a smart
phone and communicate I’ve made my phone
but what’s that you can stream live on
Facebook and social media
suddenly connections slide different and
the human interaction will change you
have to evolve because of the people
that we are and have technology going to
interface okay there’s about a 15-second
delay from what I talked to – from what
he tells me so bear with us it’s not ok
I’m just going to show me so I made the
consent form of the actual operation so
just bear with us just a minute
and essentially don’t know if you can
see this but his hemoglobin from
yesterday was 12 21 it’s white count is
10.5 his renal function is normal and
it’s 81 its CRP is a little bit up its
138 from 103 that’s because of that
pelvic connection is he booked a theatre
thank you he wishes you all the best and
he’ll see you tomorrow see you tomorrow
see you later
so this is my trainee wearing a Google
glass wearable technology streaming
through his points of view I want to
make a phone or a computer somewhere
else giving instructions by text message
which comes up in the glass saying this
is okay go ahead there’s a communication
there but I’m remote is that enough for
the patient to be thinking of the
consultant seeing him and managing his
condition or say I’m on holiday be like
me to be there for example but he’d
prefer that to somebody else it’s not
seeing him for forever there’s not his
patient for example so we’ve got to
think about how we
change the way we look after people
there’s a progress getting stronger
putting on weight I’ve gone back to work
part-time so Pamela how’d you feel about
me seeing you through a telepresence
system for example I’m right here in the
country I’m elsewhere I could just and
you come to my clinic how would you feel
do you think anything missing with a
human touch obviously we can you can see
somebody you can they can move around I
can hear their voice what about the
human touch important to me but
necessarily important it’s not necessary
but it’s nice could you cope without it
I mean the whole point is we in here
existence we think that’s important
because we created that situation that
we believe is necessary what do you
think
so the patients obviously have an
expectation an understanding of who we
are or what role that we have in that
situation what about our own colleagues
say I was the great operating theater
operates every week
what about how they communicate with me
if I wasn’t there
there you go for introductions Simon so
[Music]
looking for nice artists you’re sitting
with me on the iPad so that’s why
they’ll be confused because they have to
start the operation now they’re nice it
is that was interesting I just added
value the MDT I did my ward rounds and
and interests within about two to three
minutes the Sun becomes normalized
suddenly this machine contraption with
your face on which moves round a bit is
normality people to run ask these
questions they discuss things with you
as if you’re just there it’s incredible
that we just accept these things
changing very rapidly we need to ask the
question and to challenge the document
addition they associated with healthcare
technology of course there’s all this
there’s now art intelligence within the
next two to five years the first point
of contact will not be human being it’s
going to be AI in the background chat
BOTS other mechanisms of communicating
with people whether it’s non-human
whether it’s created by avatars so now
in parts of UK and parts of the globe
you can ask questions to a chat bot
there’s no human interface there’s no
touch there’s no eye sight it’s just
asking question after question and
algorithm based gives a diagnosis and
now it will say to you go and pay a
prescription from the chemistry be done
without ever seeing a doctor we’re gonna
used to this because this is the way we
maximize efficiency in healthcare around
the world because that chat bot could
treat millions of people in one go where
individually is much tougher so we’ve
got a global problem with lack of
resources lack of doctors so a is going
to change where you work remember the
next two to five years your first point
of contact will not be anything like me
it would just be an AI system work in
the background
we can go further what about if the AI
system becomes more realistic this is me
with a hundred four cameras creating
what’s called photogrammetry creating my
avatar a volumetric part of me what if
we add facial expression to that avatar
that’s my avatar and add human contact
and face to face expression smile the
eyes would change add voice with
interface in AI so you ask you a
question
it talks like me it acts like me it has
knowledge but much more knowledge
because I’m only confined to 22 years of
clinical practice this thing will have
knowledge across entire Google spectrum
much better than me so suddenly and that
could teach or treat
millions of people right soo expanding
healthcare you make it more efficient
and expanding and scaling up perhaps
that’s where we need to be in the future
next thing I’m going to do is an
intestine tech so we’ve had a few shoes
today
I’ll show you something that hasn’t been
trained before first time and I thought
I’d show you showcase it because TEDx is
about how we communicate in a virtual
space so give me one second and I’ll set
it up and let’s see if it works
bubbly so let’s play a video for you
which would demonstrate where I’m trying
to do a trial figured out as well as
this backbone of you know for all
example all three of us are in different
cities right now Harris and I are in
America and shoppi
they’re in London I believe we’re all
here together face to face in a noir and
we’re able to share that 3d content
whether it might be an MRI scan or
existing anatomical models and we might
be three doctors coming together able to
put our heads together face to face no
matter where we are in the world
communicate and collaborate and really
problem solve around that particular
patient and their needs
absolutely so that’s the kind of thing
we’re doing in fact I can see both in
and Harrison here with me right next to
me they’re talking to me at the moment
having conversation in the background
just similar to this so you can share
assets you can probably go ahead and
bring scans in and ultimately though we
can into be position in the future where
you may end up doing virtual reality
operations about feeding touch with
haptic loves and things in this whole
exciting space around augmented reality
virtuality mixed reality so message
really at the end of all this is the
fact that I can take soft note that
we’re going to change I think we need to
adopt different ways of managing our
patience and expectations we have to
involves human beings and I think part
of its parent psychosocial behavior what
expectations we have I’m gonna challenge
the way we’ve done things for many years
we will have a global problem of
shortage of doctors and nurses and we
also have a shortage of resources and to
improve the efficiency of our health
service and perhaps these are the kind
technologies that will help us empower
ourselves but also patients I was a
quick thank you to Pamela who’s on the
video that you saw who allowed me to
video there’s all my patients who really
support innovation who don’t mind being
shown in the world the stuff that I do
with surgery and training on the global
level but also sharing their stories
with people like yourselves and Pamela
is actually the audience today watching
this because I want to share that with
her that story thank you
[Music]
[Applause]
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