Vinod Khosla Thinks I’m Narrow-Minded

There’s a (tiny) bit of a discussion going on in Twitter about a post I wrote responding to Vinod Khosla’s statement that 80% of the work that doctors do will one day be replaced by computer algorithms.

In my post, I talked a bit about the marketplace-driven IT innovations in healthcare, and medicine as seen through the eyes of the IT entrepeneurs. I questioned just how much of what doctors do today can really be replaced by algorithms, particularly the doctor-patient relationship.

I then asked if Khosla was right and answered myself – Maybe. I stated that we were in the midst of a huge disruption in healthcare, and reflected on how I was already seeing signs of that disruption in my current practice.  And while I still did not see anything changing too much just yet, as far as the future Khosla predicted? I wasn’t so sure.

I then stated that if there is a revolution in healthcare, we docs needed to make ourselves a part of it now. I urged my fellow physicians to become involved, in order to be sure that what happens in the IT-driven healthcare future actually improves our patients’ health beyond what we are doing today.

It’s a completely legitimate concern, and, I believe, an extremely important one.  As an example, I cited the evolution of the EMR – a system that has created high hopes and caused huge disruption at enormous cost, even as we continue to struggle to find conclusive evidence that EMR use actually improves patient outcomes.

I then began to wonder what the future would look like if replacing 80% of doctor’s work with technology actually freed us up to do the real work of medicine. I imagined us then redistributing ourselves around the globe, virtually and actually, to take care of the entire planet. And called that the ultimate disruption in healthcare.

A pretty optimistic vision of the technological future if you ask me.

I thought my post was a thoughtful take on Khosla’s vision, not a takedown of it.

And yet, on Twitter, Khosla has called my post a “Usual muddy interpretation and narrow mindedness of what I said.”

How is my interpretation muddy or my take “narrow-minded”? As the end user whose work life has been radically impacted by technology, and a doctor who bears significant responsibility for the health outcomes of my patients, I think I have a right to discuss my thoughts about the healthcare technological revolution without being called “narrow-minded”.

What may be narrow-minded is Khosla’s representation of doctors as part of the problem and not the solution. I won’t get into his calling us “lazy”, or his implications that it is only the top 20% of docs – whoever they are – who are worth having around.

Maybe it’s simply that Khosla has decided that Steve Jobs was right when he said that  –  “A lot of times, people don’t know what they want until you show it to them.”

In which case, I guess we docs (and by extension, our patients) are just supposed to shut up and wait until Khosla and the rest of the IT gurus show us what we want.

Or risk being called “narrow-minded”.

Margaret Polaneczky is a board certified obstetrician-gynecologist and Associate Professor of Clinical Obstetrics and Gynecology at Weill Medical College of Cornell University. You can follow her on THCB and at The Blog That Ate Manhattan where this post first appeared.

6 replies »

  1. Interesting, and part of larger dialog between healthcare community and Silicon Valley technologists, as I’ve discussed in the two Forbes posts below (plus references therein):



    This piece might also be of interest – discusses why healthcare might represent appealing alternative/compliment to consumer web:


  2. Jonathan H –

    Of course he has the right to call me anything he wants – this is America. I was speaking, however, not of Khosla’s civil rights but of his use of the term “narrow-minded” to describe my response. In my opinion, it reveals a hubris and disrespect for what physicians do and continue to do. To belittle us for practicing medicine within the constraints of the real world (ie., how dare we ask folks to come see us in our offices? As if we had the ability to take care of patients via the internet for centuries and just refused to do it.) is just one example of this attitude that doctors are the problem. We have been as limited as everyone has been until just now. Yet somehow we are the problem and not the solution.

    Thanks for your comment.


  3. “I think I have a right to discuss my thoughts about the healthcare technological revolution without being called “narrow-minded”.

    Regardless of who is correct on the question of how far IT will penetrate the practice of medicine in our lifetimes, you do not possess the “right” not to be called narrow-minded. It may not have been polite (or smart) of him to offend you and other physicians, but if he believes you are narrow-minded he has the right to say it. And you of course have the right to disagree and respond accordingly.

  4. It seems like Khosla has deployed a logical fallacy the ad hominem (see: http://www.nizkor.org/features/fallacies/ad-hominem.html.) Logical fallacies seem to be a standard part of the playbook for those trying to promote the commercial health care products or services in which they have vested interest (for other examples, look here on Health Care Renewal: http://hcrenewal.blogspot.com/search/label/logical%20fallacies). It’s easier and more vivid than trying to construct a logical argument. And since most people are no longer educated in logic, sadly it often works.

  5. I did not write anything about your first post, but let me at this opportunity point out that Mr. Khosla does not appear to have the slightest idea about the practice of medicine and the ambiguity and heterogeneity of the diagnostic process.