senility vanity, but I remember being taught by an ‘ancient’ GP in my first year of med school, in 1976. His name was Andrew Smith, and most of us thought him amazing in many ways. One of the stories that made a deep impression on me, was how— the day after he graduated — he was delivering a baby using forceps in the mother’s own house at 3am. I would have been 18 or so and he in his early sixties —not far from where I am now. So, he would have been a medical student in the late 1930s, and I will probably stop practising medicine in the early 2020s. When I add the two professional lifetimes together at the extremes (med student to final year of practice) I am always amazed how big the number is — a span of 80 years or so. And one of our problems in undergraduate education is that we have to be concerned with these extremes: I am teaching students who will practice for another 40 years, but I have inherited a set of code written as many years in the past.
Now the above reminisce was set off by some words from Benedict Evans. He is talking about much shorter timeframes and is concerned with the commercial world. But my question for medical students (and others) is how is medicine really going to look in a few more score years, and how do we imagine all the system wide interactions that will make the future so different? This is surely more meaningful that memorising biochemical pathways.
“Everything bad that the internet did to media is probably going to happen to retailers. The tipping point might now be approaching, particularly in the US, where the situation is worsened by the fact that there is far more retail square footage per capita than in any other developed market. And when the store closes and you turn to shopping online (or are simply forced to, if enough physical retail goes away), you don’t buy all the same things, any more than you read all the same things when you took your media consumption online. When we went from a corner store to a department store, and then from a department store to big box retail, we didn’t all buy exactly the same things but in different places – we bought different things. If you go from buying soap powder in Wal-Mart based on brand and eye-level placement to telling Alexa ‘I need more soap’, some of your buying will look different….In parallel to this, TV, which so far has not really been touched by the internet, is also starting to look unstable.”