Medical Innovation: Three Questions And An Observation
As a summer sequel to last winter’s popular “three tensions in medical innovation” piece, here are three medical innovation questions — and an observation.
Question 1: Is Medical Care Getting Better Or Worse?
Most senior physicians I know speak wistfully of the good old days, the days before the fifteen minute office visit and confounding EMR systems, the days when they were doctors, not providers, respected more and metricized less.
In the eyes of many of these docs, the corporatization of medicine has robbed the profession of its vital soul, and turned a noble calling into just another job. As doctors have increasingly started to feel more like assembly-line workers than artisans, many lament that patient care has suffered.
On the other hand, most health economist and health policy experts point to data suggesting patient care and outcomes have improved as the result of the exact process “improvements” so many doctors despise. Physicians, say the critics, have resented the challenge to their autonomy and the historic assumption that the doctor knows best. Evidence, experts say, suggests otherwise.
Part of the solution here — as outlined in Vinod Khosla’s 2012 white paper – must involve the robustification of clinical decision support systems in order to leverage existing data to guide physicians away from conspicuously bad choices. Critically (in my view), such a system must also be flexible enough — truly, humble enough — to tolerate a range of acceptable options (see “Phase 1,” here), and must learn continuously over time.
It’s also essential to recognize the profound potential of the patient-physician relationship, especially in the context of serious or chronic illness and serious illness. This value of this deeply human connection goes far beyond the specific therapeutic recommendation the patient receives. Helping patients dynamically navigate illness in a way that sensitively incorporates both cutting edge scientific understanding as well highly personal patient preferences remains perhaps the most important aspect of a doctor’s job. In focusing so myopically on the discrete “selection of therapy” component, important as it is, many technologists may be misperceiving a key part of the broader “problem to be solved” here.