On Physicians, the Medical Profession, the Art of Medicine, Generic Replacements, Guidelines, Physician Extenders and Robots: Why Are We Dumbing Down American Medicine?
Years ago, one of my physician colleagues was ranting and raving about generic replacements for physician services. I listened attentively and quietly agreed that it was a bad idea. The idea is this: any physician can replace another in a production line that processes patients. This thinking is reductionism at best, but substandard care, dangerous and malevolent at worst. This is, in fact, medicine by the numbers and eradication of the Profession and Art of Medicine … eradication of the human factor and devaluation of Patient<>Physician Relationship and the personal nature of the healing relationship. This faulty thinking presumes that medicine is a perfect science, humans are like machines, and that all things can be reduced to production lines based upon guidelines, policies and procedures to be implemented by the cheapest available provider. Goal? Maximize Profit. Personalized and Best Care is lost in the shuffle of The Business of Medicine.
Is Medicine a Lost Art? Are experienced Physicians, the Medical Profession and the Art of Medicine being replaced by Generic Equivalents, Guidelines, Physician Extenders and Robots? Is The Art of Medicine on the Edge of Extinction? Why do we need the “Art of Medicine” and experienced physicians? Why am I not enchanted by the “technological advances” that are so prevalent in the medical marketplace today? Why do I want my physician to have gray hair? The guy with gray hair can think outside the box … outside the guidelines, policies and procedures … and can make sure that I get the best care, when I can’t do that for myself.
I can see the future of medicine. There will be no Physicians and no Patients. You are no longer called a patient … you, the client, scan your pay card at the vending machine complete with a flashing digital display reading “Comprehensive Health Care”. Or it might be jump started by an automatic read of your “IFD” (Implanted Financial Device) as you step into the booth, after which a rapid total body scan determines your current state of health and disease, and dispenses an immediate digital cure. Price … to be determined by the vendor, a third party. And, you don’t need to take your clothes off! This is the ultimate scenario in the transition from a quality Patient<>Physician relationship to the Robotic Care of the future … no Patient and no Physician needed. It is impersonal and automatic … based purely on the numbers. That is Medicine By the Numbers.
In his book titled Outliers and Published in 2008, Gladwell popularized the idea that it takes approximately Ten Thousand Hours of practice to achieve expert levels of performance in any field. The debate goes on and nothing is ever as simple as a single number to determine practice requirements for complex tasks, but let us presume that 10,000 hours is an approximate minimum requirement. In other words, it is a necessary, but not a sufficient requirement to achieve excellent performance. What does that have to do with Medicine, the Medical Profession and the Art of Medicine? Plenty.
The translation to Medicine is this: It takes many years for a Physician to master the Art of Medicine, because Mastery in Medicine requires knowledge, understanding and practice learning many complex tasks many of which will not be mastered for many years after formal training has been completed. Many of these fundamental, but complex tasks are learned after medical school during the early post graduate years known as internship and residency. During those years as a house staff, less experienced physicians perform under guidance of more experienced physicians. This supervised experience, a Master Consultant in Medicine who is capable of the highest achievements and best performance … especially good judgment, diagnostic skills, integrative capacity and better outcomes.
Fact: The neophite physician, or physician extender is not equivalent to the Master Physician … sorry to burst your bubble, folks. Give me the guy with gray hair who is a master of medicine … the guy who can think on his feet. And, when my gray haired physician has to give up certain tasks due to age, poor vision, stiff joints … and the usual decline we all have with age … I want my young Physician to have a gray haired Physician<>Coach … as an intimate player on my care team.
Have a Great Day and Take The Best Care™© of yourself and those in your charge.
Michael F. Mascia, MD, MPH