A Masters in Applied Digital Health to pursuing a Doctorate in Primary Care - evolving perspectives from Ashley Murray

As I prepared to travel 12,737km away from my home and all I had ever known, a question weighed heavily on my mind–what makes a good doctor? For years I had put my body on the line for my profession – sacrificing blood, sweat and tears. Sometimes even my humanity. Yet, at times, I felt as if my work involved plugging holes within the cracks of the South African healthcare system before moving on to the next patient, and the next.

This very question became the focal point of my personal statement to the admissions panel for the interdisciplinary Masters in Applied Digital Health at Oxford University. The MSc in Applied Digital Health is run by the Nuffield Department of Primary Care Health Sciences and aims to equip students with a comprehensive grounding in digital health, preparing its students to be at the forefront of positive change within this field. The rapidly evolving landscape of digital health offers unprecedented opportunities for innovation and I chose to explore this path to leverage cutting-edge technologies and bridge gaps in healthcare accessibility, quality and efficiency.

Fast forward a year later, and I am now proud to hold the Masters with Distinction from the inaugural class. Reflecting on this journey, I've come to realise:

1. People still come first

The interdependence of relationships among individuals, technology, organisations, and society underscores the importance of prioritising human connections. Innovation, if not carefully implemented, could widen healthcare disparities, especially between the private and public sectors. Furthermore, you still need people to deliver care. Digital health, while revolutionary, should not eclipse the essential human connection in healthcare. Technology should augment, not replace, the human touch in healthcare.

2. Just like the inverse care law, there is the inverse research law

Strengthening national guidelines and regulatory processes is essential for inclusive research efforts, as patient populations in routine practice differ significantly from those in controlled trials.

 
3. Rubbish in is rubbish out

This axiom was repeated multiple times by the lecturers on the course, and for good reason: in the digital health landscape, the reliability and accuracy of data directly influence decision-making, diagnoses and treatment plans. Machine learning models may produce excessively confident predictions when faced with insufficient training data. This poses a notable concern, particularly in healthcare, where inaccuracy can have severe and potentially disastrous repercussions.

4. There is no scarcity of innovation but rather a failure to implement

Despite the abundance of innovative digital health solutions globally, many face obstacles in practical implementation. Addressing this gap between innovation and application is a shared challenge among stakeholders from the grassroots level up to a legislative level.

 
5. There are inherent power dynamics in digital health

Digital enforces rather than disrupts the balance of power. Therefore, it is important to call for global initiatives to ensure ethical and equitable use of technology, advocating for solutions that empower all stakeholders.
 

Reflecting on South Africa’s own healthcare challenges, I found that our unique complexities within a resource-constrained environment offer a nuanced perspective within the global discourse on healthcare innovation. Indeed, there is an urgent need to re-evaluate our fragmented primary healthcare system and determine how digital health can either help or hinder its future. Indiscriminate integration of technology could exacerbate existing disparities among the disproportionately disadvantaged and underrepresented in digital spaces. Unlike Western-centric models, solutions for South Africa's healthcare should be contextually relevant and easily translatable. Bridging the gap between ground-breaking ideas and practical application requires an appreciation of our healthcare landscape and the diverse needs of all segments of society.

In our interconnected world, global health challenges require collaborative and interdisciplinary solutions. By immersing myself in the diverse perspectives of digital health, I am better equipped to contribute to the global dialogue on healthcare innovation. This multidimensional understanding enables me to address not only local healthcare issues but also contribute to broader global health initiatives. I encourage my fellow clinicians and digital health enthusiasts from Africa to consider this master’s. Our flexibility, culture of innovation, and resilience uniquely position us for success in Oxford and beyond. The profound lesson gleaned from this experience extends beyond the impact of Oxford shaping you; it lies in the realisation that you, with your unique journey and experiences, play an integral role in shaping Oxford itself.

One of my primary reasons for pursuing the Masters was in pursuit of inclusive research efforts in an increasingly decentralised clinical trial space. While on the course, I soon discovered that I wanted to extend my scope of knowledge through investigating a topic that I am deeply passionate about while fostering strong research methods. This led me to apply for a DPhil in Primary Health Care and thus my journey continues in seeking answers to how I can best serve my country and home. The question lingers, but the pursuit of solutions persists. And while I believe it is still important for all doctors to hold themselves, their professions and their institutions accountable with this question, I also believe that the pursuit of solutions is not just a personal journey but a collective responsibility—one that redefines, if not defiantly, what effective healthcare should look like for our communities.