The art of practicing template medicine

The art of practicing medicine is dying, soon to be replaced by the art of template medicine.

Modern medicine is based on laudable terms: “quality,” “outcomes,” “cost effective,” and “evidence based medicine,” which all sound good when sold in infomercials to the medical world and public. When examined closely, all are vague and open to abuse.

Each of these terms is intent on taking the human factor out of medicine. Each is a dagger dug into the heart and soul of the “art of practicing medicine” approach. It is my belief that, in standardizing medical care, caring for the individual is sacrificed for the sake of caring for quality indicators, protocol compliance, and cost.

The physician-patient relationship is being replaced by the physician-EMR-government-insurer-employer relationship. What a pity. Art is in the eyes of the beholders. Yes, the art of medicine is far from perfect, even marred by human frailty, but still a beautiful thing from my point of view.

I miss the good old days. My computer is like a black hole, constantly pulling me away from what I most want to do: care for my patients. The insurers and government are like a black hole, sucking in huge amounts of my energy, keeping me from patient care. On a daily basis, I fight to maintain my art.

One day, I’m going to retire. I’m going to quit being a primary care physician, drop off the grid, and settle in to being a family doc again. I’m going to thumb my nose at the EMR, the government, and the insurers. I’m going to set my own quality standards and let my patients be the judges of the pictures I paint. I’m going to return to my roots as an artist, practicing medicine as physicians have done for hundreds of years. I’m going to give individualized care to those who are in need, unencumbered by the modern world of computers, protocols, and guidelines.

I look forward to retiring to the true practice of medicine. Until then, I will work hard not to fall into the great black hole of today’s medical world.

As protocols and EMR drive behavior, modern medicine loses its heart and soul. The art of practicing medicine is dying at the hands of evidence based medicine, guidelines, and the background drone of key strokes and mouse clicks. I fear that quality care and outcomes will be measured by the art of practicing template medicine.

Stewart Segal is a family physician who blogs at

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  • Anonymous

    - Here’s a frightening thought – sooner or later, you will also be a patient. Be afraid. Be very afraid.

  • Anonymous

    Excellent thoughts.  The opposing models of care you describe were recently

  • aaronseacat

    Excellent article.  Interestingly, the opposing models of care you speak of were on display in the Oct 13 issue of the New England Journal of Medicine.  Vernon Rowe, MD wrote “Healthcare Wellness or Widgets” to express how medicine should not be compared with the manufacturing industry and patients do not wish to be treated as widgets.

  • Anonymous

    The more things change, the more they stay the same ( a French proverb from the 1800′s).  Providing the best care for patients requires face-to-face interaction and a great deal of it.  Yet, healthcare is changing, no doubt.  So, how best to accommodate  necessary changes and still keep the human touch in care?  I believe that many good physicians are doing that in their practices, from what I have seen and heard.

  • Jop

    It’s a sad but inevitable change. Technology needs to be used to make healthcare delivery cheaper and safer. The goal should be to improve the quality, access and cost of medicine. If technology helps to achieve that goal, than that takes priority over the “art of medicine.”

    • Roderick McMullen

      Technology and change are inevitable for sure, but it doesn’t have to be sad.  I agree fully that if technology helps to achieve those goals, it takes priority over the art of medicine, but they don’t have to be at odds with one another.  Software companies need to do a better job of designing technology to support the art of medicine, not hijack it. 

  • Anonymous

    I submit that the problem lies with the way most EMRs are built. They are built as “computer things” when they should be built as medical tools. This post does an excellent job of pointing out the dehumanization of medicine caused by template-based medicine. Templates are a mistake because they force doctors to adapt to computers, turning them into robotic data entry clerks, and their patients into jello molds. Luckily, there are a few innovative EMRs out there that try to do it right and harness the power of the computer to serve the doctor (and not the other way around). Full disclosure: I am employed by one of them, Praxis EMR. Medical practitioners are now in a position to vote with their wallets for the future they want for medicine. 

  • Expat Doctor Mom

    Thanks for your post.  The status of American medicine only serves to sadden me more.  Thus far, I have been quite happy practicing medicine and have not thought about getting out but, this has been because none of the offices I worked in had EMR to date…

    Best Rajka

  • Serguey Kruglyakov

    Medicine is a science course but the treatment is certainly an art. And if the treatmentceases to be art, the medicine loses its meaning as a science.

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