When I was young in elementary school, I really enjoyed the paint-by-the-numbers art kit. In each kit, you get several drawings, paint, and brushes. There are many numbered sections on the drawings. Every number has its corresponding color. So look at the number, match it with the right color, and paint.
It’s fun at first. And then it gets a bit mindless. But at the end, you’ll have a decent-looking work of art.
Non-procedural, mainstream medicine is very much like the paint-by-the-numbers art kit. You gather your history and do your physical exam. You should have a bunch of differentials, ranked from most likely to least likely. You then order tests and treatments for each differential. If you’re a good doctor, everything you do should be based on some kind of medical resource, like UpToDate, DynaMed, etc.
It is fun at first. And then it gets a bit mindless. But at the end, you’d have given decent medical care.
But if medicine is basically treating “by the numbers,” à la cookbook medicine, can’t most people do what doctors do? Treat and heal? Frankly … yes! Medicine is not rocket science. All you have to do is know how to find the information and just follow the instructions.
In the past, the practice of medicine was open to all. There was no such thing as a medical license. So those who had the knowledge (or pretended to have the knowledge) could treat.
As allopathic medicine shifted from Heroic medicine (such as bloodletting, intestinal purging, and vomiting) into science-based medicine, two main things created the barrier to medicine:
Most people can’t fathom treating others (or even themselves) because they lack knowledge. But little do they know … There is no longer a barrier to knowledge. With 2 years, and a few thousand dollars, you can buy a Kaplan USMLE review course and know as much as a newly graduated doctor. Heck, you can skip the pre-packaged courses and learn everything on the net.
The internet is the newest modern wonder. It equalizes the playing field between multi-billion dollar corporations and mom-and-pop shops. It equalities the playing field between the degree-holding professionals and the blue-collar workers. It equalizes the playing field between the 1% and the 99%. If you have the passion and the curiosity, you can learn medicine.
The only difference between a layman and a newly graduated doctor is this:
The newly graduated doctor spent a whole lot of time learning about medicine, while paying 6-figures to take a whole slew of exams that stress memorization. (Seriously, did memorizing the molecular weight of beta-HCG make you a better doctor?) Besides the time spent on learning medicine, nothing else makes the new doctor a better healer.
With enough dedication (and without having to take on a mortgage and to memorize trivia), a layman can possess the skills to become a doctor. Equip a literate person with a medical reference (i.e. UpToDate, DynaMed, etc.), and he’s has everything he needs to diagnose and prescribe.
If that is the case now, imagine what can happen in the future. As technology keeps on advancing, the knowledge advantage that doctors have keeps on shrinking and shrinking.
Think about it … Medicine — the diagnosis and treatment of diseases — is essentially similar to a computer program. If temperature is less than 100.4 °F, the patient does not have a fever. Else, the patient has a fever. If the patient has a fever, give the patient acetaminophen. Else, do nothing.
Why can’t we immortalize the science of medicine into a software program? Kinda like what the tax software does for the filing tax returns. Based on the following symptoms, these are the differentials (ranked from most likely to least likely). And here are the plans for the differentials.
The software could be so simple that even a child can run it. Eventually, the software will be replaced by a robot. I predict that in the not-so-distant future, a robot can gather the history, perform the physical exam, and dispense the treatments.
Of course, doctors will fight this progress with tooth and nail, since their very livelihood is at stake. This won’t be the first time that technology has displaced in industry. In the late 90’s and early 2000’s, the music companies tried to fight against change when the music format went from CDs to mp3s. So instead of selling individual songs in digital format, they kept on selling CDs. Most people just want one song, not the whole CD. When they cannot buy a single song, they downloaded it from file-sharing programs. The music companies tried to fight back … not by changing their business strategy, but by suing those who downloaded music illegally. Suing a single mom on welfare did not make them look good at all.
Fast forward to today. Most people don’t buy their music in CD format, but in digital format. You can try to fight against progress, but you’ll lose. So why not adapt to the changing environment?
Software and robots that can replace doctors are still a few years away. But it doesn’t mean that doctors are currently irreplaceable. Medical knowledge is pretty much the same wherever you go. Doctors in China learn the same medicine as doctors in Europe. Doctors in Latin America learn the same medicine as doctors in Northern America. As doctors, our competition is global.
Those who cannot afford the exorbitant medical fees in the US, but can afford a plane ticket and is willing to endure though the TSA, can still get their medical care. These trips are known as medical holidays. You can get your much-needed surgeries, or life-saving prescription pills, or even cosmetic enhancements overseas.
As a doctor in the US, what makes you any different from a foreign doctor?
It certainly isn’t the knowledge, but rather … the law.
A doctor in the US generally has a license (essentially, permission) to practice in a certain state. Although a foreign-trained doctor may be even more competent, more knowledgeable, and more caring, he cannot compete with you unless he too gets a license. That is very unlikely since the US medical system is set up to protect its own doctors — at the exclusion of foreigners. No offense, but it is only good politics.
Depending on the law for sustenance is a very risky tactic.
First, laws are not carved into stone. They can change for any reason and at any moment. In the mid-1900’s, the law gave DO’s the same privileges as MD’s. Both can prescribe, perform surgeries, and serve in the armed forces as doctors. Therefore, why can’t it do the same for physician assistants and nurse practitioners? Or even naturopathic doctors? (In a few states already, a ND can prescribe.)
Any day now, when another political party becomes strong enough, a doctor’s privileges will no longer be unique to him. Once there is an increased supply of medical providers, he will just be another white-collared worker.
Second, laws only pertain to certain regions. State law (and medical law) only applies to the state. National law only applies to the country. There is no law that covers the entire world.
With technological advances, what stops a patient from flying to another country for medical treatment? Better yet, what stops her from telecommuting with a doctor from halfway around the world? Next, this doctor will write a prescription and send it to an online pharmacy. Finally, the online pharmacy will mail the drug to the patient.
Truthfully, doctors are not special. Doctors who puff out their chest because of their position in society is severely deluded. Take away his license and he is a nobody, a hollow shell of his former self.
The future of doctors hangs on a single thread — politics. The US is already showing signs of change. Doctors in the US must compete with nurses and physician assistants. They must also compete with doctors abroad. Soon enough, they will compete with technology. Increased supply of medical care with stable demand means lower salaries. It really is simple economics.
How a Doctor Can Stay Competitive in the Midst of Change
Based on the collapse of the knowledge barrier and the erosion of the political barrier, doctors need a new role. They are no longer useful as an encyclopedia of knowledge. They are no longer competitive as a mere drug dispenser.
It is time to become an artist — to embrace the art of medicine and not just the science of medicine. Instead of being mechanical, emotionless, and detached, it is time to put your heart and soul into your work. It is time to really know your patients, not just as a person with certain illnesses. But like a friend.
Care for the patient’s physical well-being. But also care for the patient’s emotional well-being. Is the patient lonely? Is she going through difficult times? Did she just get a new addition to the family? What does she like to do? Who is she as a person?
Relate to her. Build a real relationship. Be human.
It is hard with the current third-party payer system, where the focus is on completing mountains of paperwork, fighting to get paid, CYA (covering your ass from lawsuits), dealing with regulations, and just trying to make a living. When this broken system needs so much of the doctors’ attention and resources, putting patients off to the side is the easy and logical thing to do.
But doing so will come back to bite you in the butt. The barrier to medical care is coming down. So why should patients come to someone who treats them like cattle?
As a (future) doctor, you have two options:
- You can be like an ostrich and hide your head into the sand — refusing to see the precarious situation ahead. Continue practicing what you have learned from your outdated medical training. Refuse to change because that is the way it is always done.
- Or you can start being more than just a regular ol’ doctor. Get away from the currently broken medical system. Stop churning patients out of the office. Stop trying to fill out mountains of paperwork to collect a pittance of reimbursements.
Instead, start by knowing your patients on a more personal level. Remember their birthdays and give them a call, wishing them a happy birthday. Invite them to an office party. Give them something they cannot get from a cold-metal computer — emotions, love, and friendship.
It is time to deviate from the cold, heartless, “efficient” medicine and embrace more of the art, the emotion, and the love of healing.
For thoughts about medicine and its future, visit the About Alex section and look for “Musings (My Philosophy on Medicine).”