Is change afoot in the practice of medicine ?

Two articles that I came across recently got me thinking about the way medicine is practised currently and how it is going to change significantly during our lifetime.

The first is an article by noted physician, writer, and policy-maker Dr. Atul Gawande; titled ‘Cowboys and Pit Crews’, it is the text of Dr. Gawande’s commencement address at Harvard Medical School last year. In this speech he touched upon the way the practise of medicine evolved and the background to the way it is currently structured. Some fragments from the speech are reproduced below to whet your appetite, hope these encourage you to read the entire article :

‘The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves…….The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. ……We’re all specialists now—even primary-care doctors. A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care…..We train, hire, and pay doctors to be cowboys. But its pit crews people need………By a system I mean that the diverse people actually work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design. They are pit crews.’

Dr. Gawande’s speech was about the systems and a process involved in healthcare delivery, and his prescriptions were practical, though complex to implement. The second article I’m pointing out to readers is a bit more far-out (or farsighted maybe), a bit like science-fiction-meets-medicine. This article is the transcript of an interview with Dr. Eric Topol, author of the book, ‘The Creative Destruction of Medicine’, a perspective on the changes in healthcare made possible by technology and digitisation. In this interview, Dr. Topol talks about the changes possible and the extent to which personalised medicine / treatment is now available and could benefit people, also about the prevailing system which (he feels) is resisting these changes.

 

  • Zenobia Driver

 

 

2012-05-21T09:35:41+00:00

5 Comments

  1. Rahul Jhaveri May 31, 2012 at 11:06 am - Reply

    A lot of value which doctor’s add to medicine is giving psychological comfort to patients. No machine can ever replicate that. The ability to psychological comfort is what differentiates practicing doctors from those involved in research. Many times researchers have a lot more academic knowledge and might be able to make a more confident diagnosis – but a practicing doctor would be more effective at treating a patient because of their approach. I agree that doctors would become more specialized over time (they already are) but they would also become more personalized.

    The idea of pit crews as opposed to cowboys makes sense mainly because practicing medicine has become more complicated attributed to medical advances in diagnosis and treatment. It would take a significant investment in time and money for one doctor to get to know everything – and the fees they would be able to charge would not justify that investment. Like with everything else, including manufacturing and consulting, things are becoming more decentralized and more about team work.

    • escapevelocityblog May 31, 2012 at 2:18 pm - Reply

      Hi Rahul,
      Very interesting sentence this – ‘The ability to psychological comfort is what differentiates practicing doctors from those involved in research’. Am mulling over it, not sure all practising doctors are able to give psychological comfort either. I think it’s partly personality driven, also that there’s not training given on this component of medical care.

      wrt your second paragraph – am glad you agree, and that you actually read the whole post and followed the links.

      Hope you like the two follow-up posts after this one too, one is already up and the other will be up on Monday.

      Regards,
      Zenobia

  2. Rahul Jhaveri May 31, 2012 at 10:32 pm - Reply

    The ability to give psychological comfort to a patient is a requirement for a practicing doctor. It is not a learned skill. Just because some doctors can not give it does not mean that it is not required of them. It just means that they are not as successful as doctors.

    Anyone can become a salesman. But a good salesman is one who not only has the right information but also the personality to sell. It is a requirement which not all salesmen meet. However, it is a very important trait. It is what makes a salesmen better at selling than a product developer.

  3. Dayane June 30, 2012 at 7:12 am - Reply

    this is very educative.

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