In medical school, you learn very quickly that you can’t know everything. By the end of your first-year anatomy course, you’ll probably give up on learning the names of every part of the body, let alone the intricacies of how they function. As physicians, we must grow comfortable with our limitations. We seek help from our colleagues and try not to let our egos get in the way of patient care. We accept that no physician will ever master the entirety of his or her discipline.
But are physicians now expected to master other disciplines, such as software engineering and social work? If you read the popular press and even academic journals you may think so. I like to call this phenomenon, this growing body of subjects doctors “should” master, “Hippocratic capture.”
I was reminded of this new pressure most recently while reading this article in a New York Times blog. The author makes some excellent points. Medical curricula are relatively stagnant while our world rapidly changes. The best medicine will incorporate modern technology and respect for the socioeconomic factors that influence patients’ health. The author also complains that he sometimes feels as if he has only one tool in his toolbox: the biomedical framework. For many health problems, this feels like simply not enough.
It’s hard to imagine any physician not empathizing with this struggle. But is the solution for medical students to take design courses from a fine arts school, as the new Dell Medical School is planning (according to the NY Times blog)? Should doctors also become designers?
Doctors face the paradox of being among the most visible and respected members of the health care field. While this authority provides many rewards, it also places an enormous expectation on us as leaders of health care. Doctors are expected to heal the sick (and we want to). If socioeconomic struggles are leading to sickness, doctors are expected to fix that. If technology provides the opportunity to democratize health care, then doctors are expected to lead the charge. We’re even supposed to design better hospital gowns according to Dell Medical School’s example of its innovative new curriculum.
But to point out the obvious: We can’t do it all! Doctors have already come to terms with our inability to master the entirety of biomedical knowledge, and we need to come to terms with our inability to personally fix every social determinant of health or poorly-designed health system. In fact, we can better provide these influencers of health the respect they deserve by allowing the true experts to take charge.
There are millions of social workers, public health professionals, software engineers, designers, and others who have the ability and desire to improve people’s health through their respective disciplines. The solution isn’t for physicians to master yet another subject; it’s to build powerful interdisciplinary teams that can address these aspects of health care in an egalitarian manner by including many kinds of experts. Doctors and other providers can no longer be the only ones responsible to the public for creating the best possible health care system. This physician-dominant model is regressive and inefficient.
I am not suggesting that doctors should ignore problems outside of the biomedical framework. I personally attended business school in addition to medical school because I was excited by the opportunity to improve patients’ health through innovative health care delivery. But I went to business school precisely because I didn’t expect the intricacies of management and economics to be taught in medical school. I don’t expect all physicians to master this part of medicine.
I am suggesting that if doctors are expected to master the multitudinous disciplines that are relevant to health then eventually the biomedical aspect of medicine will suffer. After all, despite the need to address the social determinants of health, you still need someone who knows how to take out an appendix. In forward-thinking health circles, the “biomedical framework” has become an epithet. It represents the myopia of past physicians, who thought scientists in a lab would cure every disease, ignoring issues of poverty, education, and behavior. But biomedicine is still a vital part of good care delivery and should remain at the center of medical education.
While many types of professionals can address health care policy, good design, and innovative technology, only physicians have the duty to provide medical care under the biomedical framework. When someone requires a surgery or drug for their illness, it is doctors who are responsible for ensuring the proper selection and delivery of that type of care. We can dilute our education, but we cannot dilute that responsibility.
Doctors should have some familiarity with the many disciplines that affect health. This isn’t a new idea, despite what the popular press would lead you to believe. I attended the University of Rochester’s medical school, which since the 1970’s has been home to the “biopsychosocial model” of medicine. I greatly value the broad experiences I received from learning under this medical model. Even in this environment, however, I spent plenty of time learning the pathophysiology and technical skills that are traditional parts of medical education.
I personally look forward to addressing the business side of health care in addition to providing good medical care under the biomedical framework. When I do work on issues outside of this framework, however, I expect to succeed not by knowing everything there is to know about health care delivery, but by engaging administrators, engineers, and others through interdisciplinary teamwork. If physicians are expected to be leaders of the health care system, then this is the proper way to lead. Hippocrates, after all, didn’t need an MBA or MSW to be a good doctor.
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