Age of robot doctors is approaching, says BMJ

Medicine will change more in the next two decades than it has in the past two millenniums because of advances in technology that will provide people with new means of caring for themselves, doctors believe.

Medicine will change more in the next two decades than it has in the past two millenniums because of advances in technology that will provide people with new means of caring for themselves, doctors believe.

A vision of the health service in the 21st century was presented yesterday in which patients will be more likely to consult an electronic doctor over the Internet than a live GP and will worry more about their genetic profiles than their cholesterol levels.

The stethoscope and the thermometer will be replaced by automatic sensors implanted under the skin that detect body signals and respond by delivering measured doses of drugs while patients work, eat or sleep.

At home, diagnostic toilets will analyse urine samples and send the results directly to the doctor's surgery. District nurses will conduct their rounds by interactive television.

In hospital, intelligent beds will double as operating tables, checking on patients' vital signs while providing artificial ventilation or defibrillation (for a heart attack) as necessary. Specialist heart hospitals may be sited next to pig farms to provide a supply of genetically modified organs for xenotransplantation (animal to human transplants).

At a joint press conference held in London yesterday by the British Medical Journal and the Journal of the American Medical Association, which have devoted their current issues to a discussion of how technologies will transform medicine, doctors predicted that medicine will become a global enterprise where diagnosis of a patient in Southend is as likely to be made in San Francisco.

Dr Richard Smith, editor of the BMJ said: "I think medicine will change more in the next 20 years than in the last 2,000. I think something major is happening and it is being driven by the new technologies."

Industrial-age medicine, driven by doctors and hospitals, was on the way out and it was being replaced by the "information age" of health care, in which patients relied on self help, using information gleaned from the Internet, and turned to doctors for advice. "Doctors will stop being people who tell you what to do and will become more advisers and partners who help you make decisions. This is going to be a very fundamental change and the world will look very different in five years' time," he said.

Developments in genomics - analysis of a person's genetic make-up - will deepen understanding of conditions, such as diabetes, that are a combination of many different diseases, and switch the focus from diagnosis to prediction and prevention. This will raise difficult ethical problems about the risk of creating a genetic underclass that could find itself socially excluded.

Dr Charles Wilson, a neurosurgeon and director of the Institute for the Future in Menlo Park, California, said that smaller specialist hospitals concentrating on heart surgery or hernias, where success rates were best, were being built that would offer patients hi-tech care. The rooms could be instantly converted to intensive care units with intelligent beds that monitored a patient. Patients would face less risk of infection than in a conventional shared intensive care unit.

"We believe we will see more, not fewer, hospitals concentrating on particular things, for example on transplants. Growing organs is more than 10 years away but I think xenotransplantation will be viable using genetically modified pigs. The hospital will need to be sited close to the pig farm."

For outpatients, the growing use of automatic sensors would take much of the drudgery out of medicine. "I believe within a decade sensor technology will have greatly improved the care of patients outside hospital," Dr Wilson said.