A recent article with a very provocative title caught my attention (see: Are Doctors Becoming Obsolete?). There is no possibility whatsoever that physicians will become obsolete. However, I think that their roles will inexorably change driven in part by cost-containment pressures. Here is an excerpt from the article:
The idea that physicians are going to be far less important in the medicine of the future seems to be a central assumption of many next-generation health companies....The logic goes something like is: Patients are accustomed to seeking insight from their doctors but doctors are far less good at providing this advice than most patients realize. As more consumer-based tools for managing health become available, patients will recognize that they now have the means and the motivation to take care of their health better than their physicians, and medical care will move directly into their hands....What these data don't convey, however, is something I've had the privilege to experience first-hand: Doctors enjoy an exceptionally durable bond with patients -- especially those patients with chronic illnesses. The level of trust reported by patients for their physicians is remarkable, and the role of physician as trusted adviser is difficult to overstate. It's a huge burden to manage disease on one's own, and it's generally reassuring to know your physician is with you at every step -- something I believe still happens, by the way, although obviously not in every case....So perhaps there are really two questions here: First, will doctors become obsolete? I doubt it, and suspect that reports of their demise have been greatly exaggerated. Second -- and arguably more interestingly: Should (most) doctors become obsolete -- or less provocatively, does the practice of medicine need to change? Here, the answer must be yes. We urgently need to track and review outcomes that can already be measured, and we must dramatically improve our ability to measure patient health and real-world effectiveness, so that physicians can get better, and patient care can improve.
I think that physicians are over-trained for the management of yearly physicals, minor health problems, and scrapes/bruises. These can be easily managed by nurse practitioners (NPs) and physician assistants (PAs). Such individuals will be trained to refer the potentially serious problems to physicians, assisted by medical algorithms. Such a change will be inexorable and driven by cost containment pressures and the physicians themselves who are generally opting for multi-year speciality training. The perennial shortage of primary care practitioners (PCPs) is lamented by some but I view it as an opportunity. Another opportunity is the growing sophistication of telehealth such that the nurse practitioners and physician assistants working in rural areas can turn to on-line specialists for support with complex cases. The Wikipedia entry for telehealth makes the interesting distinction between it and telemedicine: telehealth is an expansion of telemedicine, and unlike telemedicine, which more narrowly focuses on the curative aspect, it encompasses preventive, promotive and curative aspects.
The practice norm in cancer hospitals is the multi-disciplinary team (MDT) (see: The Value of "One-Stop" Breast Cancer Clinics Confirmed in the U.K.; Repurposing Outpatient Clinics and Medical Procedure Units as Integrated Diagnostic Centers). For breast cancer patients, the following specialties are commonly represented on the team: Breast Cancer Surgery, Medical Oncology, Pathology, Plastic and Reconstructive Surgery, Radiation Oncology, Radiology, and Survivorship (see: Breast Cancer: Multidisciplinary Team). Can we take this same model and move it into other care venues with a NP or PA triaging the patients? This has great appeal for me but is obviously best suited for the larger clinics and office practices.
I agree. For a variety of reasons, physicians no longer have the time or motivation to establish a strong bond with their patients. Most physician offices are like conveyor belts - see the doctor as you whiz by. The strongest bond will be with the nurse practitioner/nurse who now functions as GP's used to. So the bond that cocooned physicians is slowly getting weaker. With medical algorithms and synthetic intelligence improving each second, the writing is on the wall.
Posted by: Ajit Alles | October 27, 2011 at 09:06 AM