The author promotes change to the current means of practicing medicine.
Yet we persist in training and licensing physicians in the shadow of that model. In essence, the 20th century medical model has physicians selecting themselves, and being selected, to be trained to serve as autonomous units out in a world where we are on our own. In spite of advances in understanding and science in the 20th century, we are still to be the "Lone Ranger" in our isolated worlds. We have been oblivious to the need for the business, organizational, and leadership training required in a much more complex, interconnected medical world. Of course part of this need is because medical science and technology have advanced beyond imagining and medical education has struggled to keep up. Traditionally saddled with endless memorization and serendipity-based apprenticeship, medical training has long trailed other disciplines pedagogically.
We have already passed the point where any physician, no matter how bright, how dedicated, and how well-trained, can actually command for even a brief time the depth of any medical sub-discipline.
The issue warranting a new model for the training and practice of medicine goes beyond the means and methods of learning and using the science, the technology, and best practices, fundamental as they are. The need that we must acknowledge is how to morph from the individual-oriented education and function to that of the interconnected, team paradigm based on a new understanding of the best use of limited resources and the vastly improved ability to communicate. Electronic health records are touted as being a step to resolving some of these connectivity issues. Theoretically, the benefits seem obvious, but it may take a generation for effective implementation. Factor in the unexplored true costs, the incompatibilities, the lack of conceptive understanding and training alone, and we face a fierce headwind.
The massive challenge in getting physicians, nurses, and midlevels adjusted to a new approach is considerable. Near term, add in the effects of the new insurance coverage under the Patient Protection and Affordable Care Act of some 40 million people and the new bureaucratic mandates that accompany them, and our full plates runneth over many times. But I am looking to the next generation of young physicians whose training must be overhauled by a rethinking of roles, not just processes. Physicians show the bruised effects of having had no training in how to function in an organization, or how to adequately run a small business, or how to assume the leadership role in healthcare reform.
Watching these changes and needs evolve over time shows that the best physicians often are the ones who, through additional nonmedical training or intuition and experience, rise above and past their formal training to grasp a new understanding of a different way of functioning as physicians. They have stepped up and forward to identify what academic medicine and our existing medical affinity organizations need to do to effect the necessary changes. Unfortunately, there is no "time out" to reset or relearn a new approach, so we will have to find a way to do it on the run.
The medical profession collectively, specifically the leadership of academic and affinity organizations, must band together and commission a 21st century Flexner-like report to put us on a more effective and a more rational path. Without that awareness and leadership, we will have political and economic adverse consequences that ultimately will negatively impact our core mission, the health and welfare of our patients, and our community. We can change. We did it before, and we can-and must-do it again.
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The author practices geriatrics. Send your feedback to firstname.lastname@example.org