8 Comments

What about SUPPORT? Sometimes that is all I can do -- empathize (or whatever the latest buzz word is that means I get their concerns and their pain) and acknowledge where they are in their journey. In primary care we do a lot of that.

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Medicine is evolving rapidly, with the teaching still stuck in the archaic hierarchy model, where it is passed down through that structure. Learning never stops. I have learned more from self-education and curiosity, combined with my 1.5 years of practice, than in my 14 years of structured education combined.

With the hyper-specialization of healthcare and the exponential rise in the knowledge of modern medicine, the greatest loss I feel is to the patient. In my primary care practice, I see patients who are seeing 6 specialists. Still, nobody is communicating with each other, and in many instances, I see we do more harm than good, despite our best intentions. One of the reasons for choosing primary care for me, was to see them as a whole body, and not a system of different organs. That made me realize, how so many things are connected, not just physiologically but in terms of the interactions, and with their mental well being. I love how you have separated the different aspects of medicine, in these tiny chunks of cognition, but also how you defined the roles we still play in our patient's lives, without underestimating their importance.

However, I do feel, sometimes, we fail to connect these dots, which ideally should be a job of an internist, but at this point, has become more of a referral center for specialties, which has led to its demise in terms of a specialty. We need better generalists, than more specialists, is what I am trying to say. That starts by really teaching the process of "How to think", rather than memorizing a bunch of useless facts. I think with ChatGPT, there is a case to be made for helping us be more creative in terms of explaining complex concepts into simple ones, but also make a case for having healthy debates about what's important, and whats not in medicine.

I leave by quoting the great William Osler “The good physician treats the disease; the great physician treats the patient who has the disease.” All his quotes have stood the test of time, and again. At the end, you are just helping people.

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Thank you for sharing this wonderful article! I just discovered your newsletter and now slowly absorbing your insights!

One of my most cherished experiences (as an engineer) is to have worked closely with physicians/surgeons in understanding safety related aspects of medical devices. I believe that the medical device industry has a rich history of innovation driven by close collaboration between physicians and engineers. I hope we can see more of that in the future.

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Great and very thought-provoking piece that points out that physicians play many important roles. In a future of AI-driven healthcare, more and more of what we will do will be what you call "translate" - as you point out "patients [will] do more on their own and diagnostics [will] become more technical."

Patients can already read a lot online about their illnesses, and our job is to translate from the literature to their specific situation, and to help them understand how their unique values, needs, and history should shape their treatment choices. This needs to be done with empathy and clarity, which can take a lot of skill and patience and doesn't fit into a 15-minute visit. Would also add that physicians LEAD - healthcare is a team-based sport and physicians play important roles as team leaders. In these challenging times, those leadership skills are needed more than ever.

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I agree with all of the aspects you mention and think they are valuable parts of a clinician's role-- I have come to think over time though that one of the most important things I can offer my patients and their families (I am a general pediatrician) is the sense that I really care about them and wish them well. This can be therapeutic in itself, of course. Also, I think it's not really possible to build trust between myself and patients if they don't sense I am coming from a place of caring, thinking deeply about what is in their best interest, specific to their situation and knowing them over time. This trust facilitates much of the rest of what we do as physicians, esp in primary care. Unfortunately our health care system is not very conducive to caring connections, continuity of care, or deep thought. Still, it's worth the effort-- after years of practice, recognizing patterns of disease is no longer such a challenge, but seeing how each patient is unique and endearing (at least in pediatrics!) brings a lot of joy.

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