Sea change in medicine: Will we sink or swim?

Looking into the future, the author sees storm clouds and tsunami waves ahead on the ocean of healthcare.

Looking into my crystal ball, I see storm clouds and tsunamis ahead on the ocean of healthcare. Unfortunately, I think we're only seeing the first waves this year as we wrestle with meaningful use, part 1. Its sequels, meaningful use parts 2 and 3, promise to be gargantuan sea serpents. Pirates rather than practitioners will be better prepared to master them. Data pirates, that is. Or perhaps spies. After all, spies are masters of secret codes, of which medicine seems to have a burgeoning abundance.

Medicine hardly resembles what it was a generation ago. A colleague who took over the practice of a retiring doctor 20 years ago recalls the succinct yet complete notes of the retired doctor. A postop visit might read: "Doing well, wound clean, sutures out." Wordy SOAP notes soon supplanted such cogent summaries. When the Health Insurance Portability and Accountability Act arrived, many physicians didn't have computerized scheduling or billing systems, and some doctors decided to retire early rather than adopt new technology. Now, private practitioners are being forced into even longer and more unwieldy structured data collection. The meaningful use money will be much appreciated (if I can successfully maneuver the hoops I need to jump through), but it won't cover the full cost of adopting and maintaining an electronic health record (EHR) system.

Medicine always has changed, but the doctor's role usually was to learn new technology for healing: new surgical techniques, new medications, and better uses of existing methods. Doctors of my era weren't trained in the data management skills needed to stay afloat in the coming seas.

To sail successfully through the 21st century, medical students will need fewer courses on anatomy, physiology, and pathophysiology. These subjects will be replaced by:

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