Joe: The most dangerous person in a hospital might not be a surgeon with a shaky hand, but a patient who asks too many questions. For decades, being a 'difficult patient' could get you blacklisted. Lewis: Wow, that’s a heavy start. But it’s true, isn’t it? There’s this fear that if you question the person in the white coat, you’ll be seen as a problem. Joe: Exactly. But what’s fascinating is that today, being that 'difficult' patient—the one who comes in with research, the one who demands their own data—might just be the very thing that saves your life. Lewis: That’s a massive shift in thinking. From problem-child to proactive hero of your own health story. Joe: This whole power dynamic is at the heart of The Patient Will See You Now by Eric Topol. Lewis: And Topol isn't just some tech guru with a blog. This guy is a world-class cardiologist, a top-cited medical researcher. He's on the inside, seeing the system's flaws firsthand, which gives his arguments so much weight. Joe: Absolutely. He wrote this book back in 2015, which is interesting timing. It was right as smartphones were becoming these inseparable extensions of our bodies. He saw a future where that very device could completely democratize medicine. He called it medicine's 'Gutenberg Moment.' Lewis: The Gutenberg Moment. I like that. The idea that information, once held by a select few—the priests, the doctors—is suddenly available to everyone. Joe: That's the core of it. The printing press gave us the power to read for ourselves. Topol argues the smartphone gives us the power to diagnose for ourselves.

Lewis: Okay, before we get to that sci-fi future, let's talk about the past that needed disrupting. That 'difficult patient' label is real. I think everyone has a story of feeling rushed or dismissed in a doctor's office. Joe: Topol uses a perfect, and hilarious, example to illustrate this. He brings up an old episode of Seinfeld. Lewis: Oh, I remember this! Elaine, right? She gets a rash and can't get a doctor to see her. Joe: Exactly. And why? Because four years earlier, she had refused to put on a paper gown for a mole check, and her doctor had written in her chart, in big red letters, that she was 'difficult'. That one word on a piece of paper she couldn't see or control essentially locked her out of the system. Lewis: And then Kramer tries to steal her chart by impersonating a doctor, Dr. Van Nostrand, which goes horribly wrong. It’s comedy, but the premise is genuinely unsettling. You're at the mercy of a secret file kept on you. Joe: It’s the perfect pop culture distillation of what Topol calls "eminence-based medicine." Lewis: Hang on, Joe. 'Eminence-based medicine.' Break that down for me. Does that just mean 'because I'm the doctor and I said so'? Joe: Pretty much. It’s a system built on the authority and experience of the physician, their 'eminence,' rather than on shared data and patient input. The doctor holds all the information, and the patient is expected to comply without question. The information flows one way. Lewis: It’s like trying to fix your car, but the mechanic won't show you the manual, won't let you look under the hood, and won't even tell you what's broken. They just hand you a bill and say 'trust me.' Joe: That's a perfect analogy. And while it's funny on TV, Topol shares a much darker, deeply personal story that shows the tragic side of this model. He talks about his own maternal grandparents in the 1960s. Lewis: Oh, wow. What happened with them? Joe: Within six months of each other, both his grandmother and grandfather developed the exact same symptoms—a bowel obstruction. They had the same surgery, the same rapid decline. It was clearly something serious, likely a terminal illness. Lewis: And the doctors told them what was going on? Joe: Not a word. The doctors never disclosed to either of them that they had widely metastatic colon cancer. They let them die without ever knowing their own diagnosis. The family was told, but the patients themselves were kept in the dark. Lewis: That's heartbreaking. To be robbed of the chance to understand your own body, to say goodbye on your own terms… all because the doctor 'knew best.' Joe: It was the peak of medical paternalism. The Hippocratic Oath, as Topol points out, is completely silent on the issue of communication with the patient. The system was designed to protect the patient from the truth, not empower them with it. Lewis: So Elaine Benes being labeled 'difficult' is the comedic tip of a very tragic iceberg. The real issue is this fundamental information imbalance that can have life-or-death consequences. Joe: That's the world Topol says we are finally leaving behind.

Joe: Exactly. That paternalistic silence is what Topol argues technology can shatter. It allows for the rise of what he calls the 'smart patient.' Lewis: The opposite of the 'difficult' patient. This is someone who is informed, engaged, and armed with data. Joe: And sometimes, they're armed with more data than their own doctors. Topol tells the story of Kim Goodsell, which is one of the most incredible case studies I've ever read. She was an athletic woman who, at age 40, developed a heart arrhythmia. She's diagnosed with a rare heart condition. A few years later, she starts developing neurological symptoms, muscle weakness. She gets a second diagnosis for a rare neurological disease. Lewis: Two different rare diseases at once? The odds of that must be astronomical. Joe: That's exactly what she thought. It didn't make sense. So, what does she do? She doesn't just accept it. She spends the next two years at her computer, teaching herself genetics and molecular biology from scratch. Lewis: Wait, she taught herself genetics? Like, from zero? Joe: From zero. She dives into online medical journals and genetic databases. She starts mapping out the biological pathways of her two conditions, looking for a link. And she finds one. A single, incredibly rare mutation in a gene called LMNA that could explain both her heart problems and her nerve issues. Lewis: That's a real-life House M.D. episode, but the patient is the detective. So what did she do? Did she just email her doctor and say, 'Hey, I think I solved it'? Joe: Essentially, yes! She went to her world-class physicians at the Mayo Clinic, presented her research, and requested they sequence that specific gene. They did. And she was right. Lewis: That is absolutely mind-blowing. She literally diagnosed herself with a condition her own expert doctors missed, all because she had access to information and the drive to use it. Joe: It's the ultimate 'smart patient' story. And it led to a real outcome. Knowing the specific mutation allowed her to change her diet in a way that actually alleviated some of her symptoms. She took control. Lewis: And you see this pattern emerging elsewhere. The book talks a lot about Angelina Jolie's choice, which was another huge moment for this movement. Joe: A massive moment. Jolie had a family history of cancer, so she got genetic testing. The test revealed she had the BRCA1 gene mutation, giving her an extremely high risk of breast and ovarian cancer. But instead of waiting for a diagnosis, she used that data to make a proactive, preventative choice: a double mastectomy. Lewis: And she wrote about it publicly. That was the key. She took this private medical data and made it a public conversation. Joe: It created what's now known as the 'Angelina Effect.' A huge spike in women seeking genetic testing and taking control of their health based on predictive data. She showed millions of people that you don't have to be a passive recipient of your genetic fate. Lewis: This all sounds amazing, a true revolution. But I have to play devil's advocate here. There are risks, right? The book itself mentions the FDA cracking down on the genetic testing company 23andMe around the time it was published. Isn't there a danger in people misinterpreting their own data? Can we really trust 'Dr. Google' over a trained physician? Joe: That's the critical question, and Topol addresses it head-on. The controversy with 23andMe was about a company making medical claims without FDA approval. The FDA was worried that a false positive could lead someone to get unnecessary surgery, or a false negative could give someone a false sense of security. Lewis: Which seems like a reasonable concern. We can't all be Kim Goodsell and spend two years becoming a self-taught geneticist. Joe: We can't. And Topol's vision isn't about replacing doctors with algorithms. It’s about changing the relationship entirely.

Lewis: Okay, so if it's not about firing our doctors and just using our phones, what is the new relationship? What does the future of a doctor's visit look like in Topol's world? Joe: It becomes a partnership. The power dynamic flattens. The patient comes to the table not as an empty vessel, but as an expert on their own body, armed with their own data—their sleep patterns, their heart rate from their watch, their genetic predispositions. Lewis: So the patient brings the raw data, the 'what'. Joe: Exactly. And the doctor's role shifts. They are no longer the sole gatekeeper of information. Their value comes from what a smartphone can't provide. They become an expert interpreter, a guide, a strategist. They help you make sense of the noise in your data. Lewis: They provide the 'so what' and the 'what now'. The wisdom. Joe: And most importantly, they provide the human connection. Topol quotes another physician, Abraham Verghese, who said, "You can heal even when you cannot cure by that simple act of being at the bedside—your presence." Technology can handle the diagnostics, the monitoring, the data collection. That frees up the doctor to focus on the uniquely human parts of medicine: empathy, reassurance, and healing. Lewis: I love that. It actually makes the doctor's job more human, not less. It takes the robotic parts away and leaves the core of what makes a great healer. Joe: The book argues that the phrase "The doctor will see you now" is becoming obsolete. It’s being replaced by a conversation. Lewis: So it's moving from a monologue to a dialogue. The patient brings the data, a smartphone might bring the diagnosis, but the doctor brings the wisdom. Joe: That’s the vision. A democratized, more humane, and ultimately more effective model of medicine. Lewis: It makes you think—the next time you're in a doctor's office, are you a passive 'patient' or an active partner? Joe: A question we should all be asking ourselves. Lewis: We'd love to hear your experiences with this. Have you ever felt like a 'difficult patient' for asking questions? Or have you had a great experience partnering with your doctor? Find us on our socials and share your story. Joe: This is Aibrary, signing off.