Thursday, September 30, 2010
The medical profession: Is it devolving?
I had lunch with a group of physicians recently, and along for the ride was a college student thinking of applying to medical school. When talking about the future, I suggested that the work of a physician 30 years from now will be hardly recognizable to today's physician. Everybody disagreed and the student was confused. There was a lot of denial and myopic rationalization.
But I can't blame them, really. Most of us see what's immediately changing in our day-to-day work and the bigger picture gets lost. For most of us, the role of the physician is hard to see for anything other than it always has been. Most live and work as the self-determined independent care coordinator, reactively working to treat disease just as it has been done for over a century. But change is happening around us.
I see three forces driving change in the physician role:
Technology. In the 19th century we treated symptoms. In the 20th century we treated diseases. In the future we will predict and prevent disease. Much of what we do diagnostically will be replaced by technology.
Third-party control. The days of independent decision making are numbered. Evidence-based measures rooted in resource control will rule the future. Much of what we do will slowly approximate automation.
Patient empowerment. Since the dawn of medicine physicians have been defined by their unrestricted access and control of information. But unbridled access to information is changing the role of the patient. This shift is changing the way we see patients and the way they see themselves.
I'm in no way predicting the end of the physician. There will always be disease and the need for a human docent somewhere amidst all this technology, information and administrative control. I just think that the way we understand the physician will be remarkably different 30 years from now.
As doctors, none of this is in our control. But we may ultimately be defined by the role we play as these changes evolve.
I want to cultivate this into something a little more involved. If you have any ideas that might be helpful, leave a comment here. If you're a transparency-conscious physician, feel free to drop me a line via electronic mail or tightly sealed envelope.
This post by Bryan Vartabedian, MD, appeared at Get Better Health, a network of popular health bloggers brought together by Val Jones, MD. Better Health's mission is to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the provider point of view on health care reform, science, research and patient care.
Labels: health care delivery, health policy, medical education
posted by the Better Health network at
10:22 AM
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2 Comments:
I'd say that medicine is evolving, i.e. getting better - largely in response to two forces you outline: new technology and patients' engagement in decisions. Part of doctors' resistance, maybe, comes from the fact that each of these factors represents "work": we have to keep up with scientific advances in molecular biology and other areas, and also pay more attention to patients' concerns and values.
I believe another force is also at work,the changing face of medical ethics or in current parlance, Professionalism.The introduction of the concept of physicians as stewards of society's resource is very recent.Thirty year ago there was no talk of balancing society's needs with your patient's need nor of a physician obligation to work for "social justice".A major step in the paradigm shift was the introduction by the ACP and a comparable organization in Europe was the "The New Medical Professionalism" It has been argued that a change in ethics was necessary because of the changes in medical economics, ,i.e. the role of third party payers.It that regard Dr. Edmund Pelligrino asked in 1995 "Is medical ethics a social,historical or economic artifact?Or there some universal, enduring principles? More and more it seems that the primacy of the fiduciary duty of the physician to the patient's interest is looking like an economic artifact of an earlier era.
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