Don’t let guidelines guide your curiosity

Albert Einstein once said, “The important thing is not to stop questioning. Curiosity has its own reason for existing.”

No matter how advanced our artificial intelligence is and continues to evolve, it lacks the reproducibility of the powerful human instinct, sense of curiosity and constant questioning; especially when resulting in that “wow” moment of important scientific discoveries. Were it not for these powerful traits, medical science could not have evolved to the levels of our currently achieved milestones. Just because we question something does not make us cynics. In fact, questioning in medical science is the natural sieve for achieving progress.

This brings us to the decade leading up to 2017, a year of consolidated evidence-based medical practice guidelines. These criteria have become the catchphrase for even retail medical interests and have evolved into a frighteningly (at times) enforceable mandate in today’s health care community. If insurers are threatening to withhold compensating physicians who wander outside of guideline territories, we urgently need to question or certainly redefine a doctor’s role in clinical medicine and work on remedial measures to lift such limitations to assure unfettered physician care.

Taking a step further back, just imagine the following: Most of medical education comes from Medicare, Medicaid, hefty tuition (“sell your soul” to the devil loans), pharmaceutical sponsorships and subsidies (even if to a lesser degree). This entraps the future physician to work for the same Medicare, Medicaid system (which also determine other insurer fee schedules), pay back loans and practice medicine based upon a largely pharmaceutically sponsored and co-created “evidence-based” medical guideline trajectory. Our government encourages and enforces pharmaceutically co-created guidelines which have become the basis of medical education and help mold our future physicians.

What happened to discouraging physicians from being influenced by pharmaceuticals? Where’s the Sunshine Act when it comes to medical schools? Why aren’t these self-sacrificing students subsidized by the government as well? After all, tuitions have become prohibitively unfordable. In fact, future physicians are indentured into financial slavery. Forced into paying back steep loans and the growing hardships imposed upon them, it’s no wonder they are extremely unhappy, disillusioned and are quickly introduced to burnout and even suicide. Just how can physicians gladly deliver upon the real debt they owe their patients? So, imagine if real cure medical innovations that are unhampered by constant interest vested, guideline-directed, administrative and regulatory controlled firewalls where physicians are no longer controlled every step of the way?

Would we be worse off? Can we even be less stressed or burnt out and reduce our suicide rates? Perhaps, we might experience overall better health for ourselves and our patients? More than just likely, we might progress towards an era of genuine clinical and scientific, curiosity led innovations that have been the foundation and cornerstone of American medicine for the last few decades. Indeed, we would most likely thrive in our sense of accomplishment and once again appreciate being members of a noble profession. In fact, instead of just keeping our patients well and medicated, we’d gladly pursue a more holistic, healthier approach. We would refer to evidence guidelines when our own clinical and conscious guidelines coincide with the former instead of acting as their subjugates. Our important guidelines would never be discarded. They’d become much more valuable by being dynamic, ever-changing, clinically modulated and adapting to breathe more truth into how we practice medicine.

How many medical school, residency or postgraduate courses offer totally industry free, independent thinking, innovation, challenging and questioning the status quo of health care?

After all, five of the 56 signers of our Declaration of Independence were physicians. They weren’t complacent, and we shouldn’t be either.

Now you must understand innovation and curiosity are still valued and encouraged, mostly when helping bottom lines of huge corporate interests. Even many of these innovations can be extremely advantageous. Still, most real advances are financially driven.

What’s happening to American medicine?

It looks like it’s a disheartened business model that has “body snatched” the original intent and spirit of medical science. We need to reclaim our greatness and once again become leaders of our noble profession instead of “guided “providers.”

Simply put, a doctor ten years ago, and many still today would concentrate on “treating” the patient. Whereas most of today’s practitioners seem forced into a situation of providing “treatments” instead. Unfortunately, in this new equation, it’s the physician who seems to be the missing constant. Bright, young physicians are “getting it.” Their notable disillusionment, discontent, unhappiness and early yet fast-tracked road to burnout is becoming today’s ignored norm. You wouldn’t always see it as their recent “boss man” (yes, mostly hospital, mega group, insurance companies employ doctors or their previous practices) use multimedia marketing and Photoshop out their growing discontent with unimaginable ease. Thanks to the internet, social media and growing vociferous physician discontent these facts are no longer as easily swept under the carpet.

Naysayers will argue how these are complaints and notions of our older generation physicians. Yet it’s almost every day that I hear from so many of our bright, recently trained, highly dedicated and caring physicians who never got what they signed up for — and instead, continue to suffer in silence. All generations of physicians are equally troubled by their frequent inability to serve patients in a manner they’d idealized, imagined and are capable of.

I encourage our medical students, residents and recent graduates entering the various fields in our profession to exercise their right to constantly question, lest they soon become mere appendages to various forms of artificial industry driven intelligence. There’s still time and hope to avoid our recent physician grads from being totally unprepared in dealing with their own unexplored and wasted potential as well as their very humanity. Allow your curiosity and imagination guide you each day rather than be blindly led by guidelines alone.

Michael Weiss is a physician and can be reached on Twitter @HeartAndSoulDoc.

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