医生八成工作将由科技代劳

    在其它一些我们认为需要由人进行判断的领域，由人力向自动化的转变已经发生了。比如大多数民航飞机现在都是自动导航的，而不是由机长驾驶。大多数股市交易都采用算法交易。谷歌（Google）的无人驾驶汽车已经在普通街道上安全行驶了30万英里。机器取代人力的革命也同样会发生在医疗领域。它将有助于更全面地了解病人病情，通过更加个性化的疗法提高治疗效果。医生将有更多的时间与病人进行交流，以找到那些难以精确度量的信息，因为他们不必再像过去那样，把大量时间花在收集数据和看病例上。现在他们可以同时处理更多的病人，降低成本。

医疗创新的源泉

    这些创新来自哪里？有人认为，我们应该在现有医学成就的框架内进行努力。我不同意这种看法。

    创新很少从内部发生，因为现有机制的设计往往并不鼓励颠覆性的创新。制药企业总是推出各种药物，而不是研究更好的治疗方案，因为他们想要你不断地买药，让他们尽可能长久地赚取利润。医疗设备公司也不想提供更便宜、更易用的监测设备，这样他们生产的那些昂贵的仪器就卖不出去了。这些传统玩家会用各种手段软磨硬泡，使医生和监管机构对创新说“不”。让这些医疗机构创新，就是让他们降低自己的利润。当然，这是泛泛而谈，社会上也有许多出色的、有良心的医生和机构。

    幸运的是，现有的这些成功的医疗机构是否带头创新并不重要，因为创新无论如何都会发生。而且创新可能会从外围发生，比如美国有4,000万人没有保险，印度有成百上千万人看不起病。医疗创新使得投入到固定设备上的资金得以减少，削减了成本。它使我们可以向那些看不起病的人提供基本的医疗服务。它可以帮助我们减少失误。而且它可以避免小病拖成大病。

    企业家可以担当起这些挑战，为创新打开新的视野。他们提出的一些貌似天真的问题有时直指问题的核心，有时还会发现一些尚未被人们察觉的问题。他们可以利用许多医学界人士为他们提供对医学的理解。他们可以打造智能的电脑程序，在削减医疗成本的同时，优化医疗服务。

    这次革命需要一些时间，但不会像人们认为的那么久。它可能沿着好几个方向开始，其间经历多次修正、后退和失误。也许我们很快就会看见颠覆性的创新了。许多天真的创新人士，甚至他们中的90%，都会在尝试创新后失败。但是少数人将取得成功，改变整个系统。对于那些支持企业家和企业进行变革的人来说，大多数投资也会以失败告终。但是仍有少数投资者会获得成功。总的来说，挣到的钱将比损失的多。没人知道这个领域会变成什么样，但无疑有一个巨大的机会正摆在科技人士、企业家和其他高瞻远瞩的人面前。同时，这也是一个降低医疗支出、提高医疗服务质量的好机会。

    本文作者Vinod Khosla是位于加州的门洛帕克市风投公司Khosla Ventures的创始人。

    译者：朴成奎

    A transition to automation has already happened in other areas where we once thought human judgment was required. Most commercial flying is now done by auto-pilot, not by the captain. Algorithmic trading now drives most stock market volume. Google's (GOOG) self-driving car has had zero accidents driving 300,000 miles on normal streets. The same replacement of human involvement by computers will also happen in healthcare. This will create a more comprehensive understanding of patients and improve health outcomes with more personalized treatment. Physicians will have MORE time to spend talking to their patients, making sure they understand, socializing care, and finding out the harder-to-measure pieces of information because they'll spend a less time gathering data and referring to old notes. And, they will be able to handle many more patients, reducing costs.

The source of healthcare innovation

    Where will all this innovation come from? Some believe we have to work within the constraints of the medical establishment. I disagree.

    Innovation seldom happens from the inside because existing incentives are usually set up to discourage disruption. Pharma companies push marginally different drugs instead of potentially better generic solutions because they want you to be a drug subscriber and generate recurring revenue for as long as possible. Medical device manufacturers don't want to cannibalize sales of their expensive equipment by providing cheaper, more accessible monitoring devices. The traditional players will lobby/goad/pay/intimidate doctors and regulators to reject innovation. Expecting the medical establishment to do anything different is expecting them to reduce their own profits. Granted, these are generalizations and there are many great and ethical doctors and organizations.

    Fortunately, it doesn't matter if the establishment tries to do this or not, because it will happen regardless. And it may start at the periphery, e.g. with the 40 million uninsured Americans or the hundreds of millions of people in India with no access. This shift in healthcare delivery will allow for less money to be spent on capital equipment, cutting costs. It will allow us to provide care and basic service to those who can't afford it now. It will help avoid errors. And, it will prevent simple things from getting worse before being addressed.

    Entrepreneurs can come at these challenges and inject new insight. They can ask naïve questions that get at the heart of pervasive and sometimes unperceived assumptions. They can leverage the many insiders to provide real understanding of medicine at the right time. They can build smart computers to be objective cost minimizers while being care optimizers.

    This evolution will take time, but it won't take as long as people think. The move will happen in fits and starts along different pathways, with many course corrections, steps backward, and mistakes. Maybe we'll start seeing disruption at the fringes. Many naïve innovators, maybe even 90% of them, will attempt this change and fail. But, a few will succeed and change the system. For those of us who support entrepreneurs and companies that create this change, most investments will be lost, but more money will be made than lost through the few successes. None of us knows how this space will turn out, but there's a huge opportunity for technologists, entrepreneurs, and other forward-thinkers to reduce healthcare expenditures and improve patient care at the very same time.

    Vinod Khosla is the founder of Khosla Ventures, a venture capital firm in Menlo Park, CA.