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Disruptors Remaking the Medical Model


We are living in a culture of headlong, head-over-heels disruption. The future may be uncertain, but it certainly will contain wonders. All hail disruptors!

Mankind's history — and therefore medicine's history — has shown stagnation for centuries, creeping change for decades and now a headlong, head-over-heels culture of disruption. We are experiencing change of all kinds, at all levels of our experience and almost completely unpredictable as to its consequences or next incarnation. It is at the same time both heady and disorienting. And with medicine being a foci of our civilization's hopes and conflicts, our professional charge is of even greater import than previous generations' because of the far greater potential to make a difference in people's lives.

The first revelatory changes that come to mind are medical scientific advances: DNA and its implications; imaging; anesthesia; germ theory and immunization; public health; and so on in our more familiar realm. And even here we are now daily playing catch-up, at best.

But think about some of the disruptors to our lives and to medical practice that we do not ordinarily associate with medicine. Take the automobile for instance. It has utterly changed not only accessibility but also the basic medical model that preceded it. It's a form of time machine that opened up uncountable changes in what and how we do it.

And the same with electricity, from telephones and the light bulb to all the devices that we take completely for granted. EKGs, computers, the internet and "we get it."

How about the development and spread of the insurance idea? Even today, much of our public discourse about medicine revolves around how to better manage some of the unintended consequences of health insurance; permitted runaway costs and inequity of their application, for instance. Sometimes it seems the "cure has become worse than the disease." Another disruptor we could not have predicted. Another disruptor to analyze post hoc and struggle our way out of.

We are now arrived at what appears to be a seemingly permanent cusp of change and we, as a society, and as a profession, haven't quite yet figured out how to adjust or manage our new reality.

The Anticipatory Corpse: Medicine, Power

I raise these issues, in part, because of some questions raised by Jeffrey Bishop in his new book . There is an underlying culture and philosophy of medicine, as there is for all human endeavors. We doctors share the human tendency to intuit and function within the culture and subcultures that we inhabit, usually without stopping to codify or analyze what and why we do what we do the way that we do it.

But with frequent changes — major and minor, recognized and unrecognized — fraught upon us, it has become distressingly easy to become disoriented. Not just anxious, but increasingly confused about our purpose and methods.

In spite of our best efforts, it has become physically impossible for physicians to stay abreast of burgeoning medical developments. It sometimes makes the idea of universal achievement of "best practices" and "evidence-based medicine" almost moot.

With all of these disruptors and changes, the human yearning for surcease from suffering and death has vastly increased expectations from medicine over the last few decades. Practical futility, a historic fact of medical practice, the historic driver for a supernatural relief, has in recent decades weakened its grasp a bit upon human affairs, including medicine, as a result of scientific and technological advance.

As Bishop puts it, the "rules that operate beneath human consciousness at a given historical moment" are being quietly altered, albeit with no small emotional and social cost. So it is with disruption and new possibilities. The old "good news and bad news."

We are even beginning to hear and think the early glimmerings of the possibility of a historic, indefinite life extension, not just improvement. Sigmund Freud maintained that the knowledge of a certain death is the fundamental fact at the center of every human's psyche. And Bishop adds that “the repression of death … is at the core of medicine."

Except that now, due to unpredicted scientific and social disruptors, we might dare to dream that such a thing might in future be within our grasp. It's heady stuff for the next generations, especially of doctors.

I often listen to doctors in training while they fret and ventilate about their uncertain economic and organizational futures in the face of such "permanent revolution". Then I point out that they will a) live well and be able to feed and educate their children, b) achieve what brought them to this profession in the first place with a chance to serve and be useful and c) achieve and witness medical developments that we in the here and now can only dream about. I tell them all previous generations of doctors would do or give anything to see and do what they will be granted the ability to see and do.

The future may be uncertain, but it certainly will contain wonders. All hail disruptors!

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