But this "war room" does not belong to a hospital. It belongs to Philips, a Dutch electronics company. Mr Goudswaard, the head of innovation for Philips's home-monitoring business, has no medical training. His speciality is the consumer.
The past 150 years have been a golden age for doctors. In some ways, their job is much as it has been for millennia: they examine patients, diagnose their ailments and try to make them better. Since the mid-19th century, however, they have enjoyed new eminence. The rise of doctors' associations and medical schools helped separate doctors from quacks. Licensing and prescribing laws enshrined their status. And as understanding, technology and technique evolved, doctors became more effective, able to diagnose consistently, treat effectively and advise on public-health interventions—such as hygiene and vaccination—that actually worked.
This has brought rewards. In developed countries, excluding America, doctors with no speciality earn about twice the income of the average worker, according to McKinsey, a consultancy. America's specialist doctors earn ten times America's average wage. A medical degree is a universal badge of respectability. Others make a living. Doctors save lives, too.
With the 21st century certain to see soaring demand for health care, the doctors' star might seem in the ascendant still. By 2030, 22% of people in the OECD club of rich countries will be 65 or older, nearly double the share in 1990. China will catch up just six years later. About half of American adults already have a chronic condition, such as diabetes or hypertension, and as the world becomes richer the diseases of the rich spread farther. In the slums of Calcutta, infectious diseases claim the young; for middle-aged adults, heart disease and cancer are the most common killers. Last year the United Nations held a summit on health (only the second in its history) that gave warning about the rising toll of chronic disease worldwide.
But this demand for health care looks unlikely to be met by doctors in the way the past century's was. For one thing, to treat the 21st century's problems with a 20th-century approach to health care would require an impossible number of doctors. For another, caring for chronic conditions is not what doctors are best at. For both these reasons doctors look set to become much less central to health care—a process which, in some places, has already started.
Make do and mend
Most countries suffer from a simple mismatch: the demand for health care is rising faster than the supply of doctors. The problem is most acute in the developing world, though rich countries are not immune (see article). It does not help that health care is notoriously inefficient. Whereas America's overall labour productivity has increased by 1.8% annually for the past two decades, the figure for health care has declined by 0.6% each year, according to Robert Kocher of the Brookings Institution and Nikhil Sahni, until recently of Harvard University. But it is in poor countries that interest in alternative ways of training doctors and in alternatives to doctors themselves has produced the most innovation.
One approach to making doctors more efficient is to focus what they do. India is home to some of the world's most exciting models along this line, argues Nicolaus Henke of McKinsey, who leads the consultancy's work with health systems. Britain has 27.4 doctors for every 10,000 patients. India has just six. With so few doctors, it is changing the way it uses them.
Your correspondent recently watched Devi Shetty, chief executive of Narayana Hrudayalaya hospital in Bangalore, making careful incisions in a yellowed heart, pulling out clots that resembled tiny octopuses. It looked difficult. Some of the other tasks at Narayana Hrudayalaya hospital do not, and are not. Dr Shetty's goal is to offer as many surgeries as possible, without compromising on quality. To do that, he ensures that his surgeons do only the most complex procedures; an army of other workers do everything else. The result is surgeries that cost less than $2,000 each, about one-fifteenth as much as a similar procedure in America.
The trick is repeated in other areas of health care. India's LifeSpring hospitals slash the price of childbirth by augmenting doctors with less expensive midwives. The costs are about one-sixth of those in a private clinic. The Aravind Eye Care System offers surgery to about 350,000 patients a year. Operating rooms have at least two beds, so surgeons can swivel from one patient to the next. Most important, for every surgeon there are six "eye-care technicians"—young women recruited and trained by Aravind—who perform the myriad tasks in the operating room that do not require a surgeon's training.
Other problems have inspired other solutions, with technology filling gaps in the labour force. The Bill and Melinda Gates Foundation supports a programme that uses mobile phones to deliver advice and reminders to pregnant women in Ghana. In December the foundation and Grand Challenges Canada, a non-profit organisation, announced $32m in grants for new mobile tools that will help health-care workers diagnose various ailments. In Mexico, worried patients can phone Medicall Home, a "telehealth" service. If a patient needs care, Medicall Home can help to arrange a doctor's visit. But about two-thirds of patients' concerns can be addressed over the phone by a doctor (often one only recently qualified).
These programmes are expanding. Medicall Home is rolling out its service in Colombia and plans to be operating in Peru by the end of the year. Aravind has exported its training model to about 30 developing countries. Dr Shetty already has 14 hospitals in India. He plans to add 30,000 hospital beds in big health complexes and small hospitals there over the next seven years, as well as build a hospital in the Cayman Islands.
Technology does not just allow diagnosis at a distance—it allows surgery at a distance, too. In 2001 doctors in New York used robotic instruments under remote control to remove the gall bladder of a brave woman in Strasbourg. Robots allow doctors to be more precise, as well as more omnipresent, making incisions more neatly than human hands can. As yet they are enhancements for surgeons more than they are replacements, but that may change in time. Military drones started off being flown by officers who had gone through the expensive rigours of flight school; these days other ranks with far less exhaustive training can take the controls.
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