How the modern doctor was created

November 14, 2018

In his latest book, Rajeev Kurapati, MD, explores the history of medicine and what physicians can learn about today’s transformations

How was the modern doctor made?

That’s the key question Rajeev Kurapati, MD, MBA, set out to explore in his latest book, “Physician: How Science Transformed the Art of Medicine” not only for himself, a practicing hospitalist for the past decade, but for his fellow physicians.

Kurapati, who practices at St. Elizabeth Medical Center in Northern Kentucky, says you have to start at the beginning-as in 2,000 years ago-to trace how the doctor transformed from a priest and a healer to become today’s technologically driven provider of care. And it’s critical to look at the digitization of medicine not only in the evolution of the profession, but also in terms of what it will mean for the future.

Kurapati recently talked about the book and the state of medicine with Medical Economics. The following are excerpts from that discussion.

Medical Economics: Why is it important to explore the transformation of medicine?

Kurapati
: I thought I would write a book on the history of medicine, looking at where we’ve been and where we’re going and why that matters. I wanted to write something conversational and accessible that gave doctors, healthcare providers, and patients a good overview of the field of medicine-how doctors practice, how they think, and how patients are impacted by advances in medicine. That was the idea behind the book.

In the past, practitioners would look at the whole human being and say, “Okay, you have a stomach pain, but how are you sleeping? How are your family members? What are your relationships like? What do you eat?” That sort of holistic thinking came before the invention of disease-centric medicine, because healers needed all this information to make their assessments.

When we switched to a disease-centric approach, specialists emerged. In many ways this was helpful, but it also meant these doctors started seeing people not as human beings in total but mostly as, “This is my organ of interest, so I’m just going to focus here.”

When that happened, we started losing the human touch with our patients. It became a piecemeal approach to practicing medicine. This was the compromise we doctors had to make. There’s so much of an information overload that the explosion of knowledge, this explosion of information, was so great that at the individual level we couldn’t keep up.

ME: You talk about the current state of technology in the book. How can physicians find more help than harm from their new tech tools?

Kurapati
: We have to endure the growing pains of technology. Even if we don’t embrace technology, it doesn’t mean it’s going to stop-it just means we’ll be imposed upon by industries, profit makers, and governments. Either we embrace it or it moves on without us. The younger physicians-the millennial physicians-they have to take charge of technology and steer it in the direction they see is going to make it the most useful and valuable. And the more experienced physicians have to be ready to go with the flow.

ME: You’ve said you wrote the book “to answer the question of ‘Who am I as a physician?’” What lessons did you learn and what can you share with your peers?

Kurapati
: One of the biggest lessons is to embrace technology. This technological revolution is going to transform and help [physicians]. With that in mind, make sure you first understand its usage. The more you resist, the more monstrous it becomes, because it’s just going to keep advancing.

Then, steer it in the direction that you want it to help you. That’s how you enhance its capabilities to become the most useful.

Second, slow down. Doctors are stuck in a fast-paced lane where salary or compensation is based on the number of patients we see and the number of days we work because the practice of medicine is a fixed service that we provide for a fixed price.

I’d caution my peers not to keep seeing more patients because you want to make more money faster. That’s an easy way to lose track of why you signed up for this job in the first place. You signed up so you could help others alleviate or manage their suffering, and that’s where you derive satisfaction in this field.

Recognize that you can slow down, spend some personal time, carve out moments of silence in your life and reflect upon the previous day.
Ask, “How can I make my life better?” and “How can I make the lives of others better?” This mindfulness improves our ability to care for others.

These questions get to the point of the book. When we introduced the scientific method, we decided we were going to examine only the things that could be measured-blood pressure, blood sugar, heart rate and so on. But this method is incapable of taking into account the human attributes that aren’t measurable. Fears, biases, prejudices, beliefs-these are apprised human attributes, and they’re necessary to help paint a complete patient picture.

In many practices today, a patient comes to a physician’s office and is nothing more than a bunch of numbers in a chart because the scientific method trained us this way.

If we don’t realize there are certain human attributes that are beyond the boundaries of this objective method, then we are losing the human connection, we are losing the reason why we are here in the first place as doctors, which is to yield suffering.

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