“But I Just Came Here To Talk..” by Pat Conrad MD

Should medical schools recruit like the big tech firms?  “Dr. Stephen Klasko, the president of Thomas Jefferson University in Philadelphia and CEO of Jefferson Health, says that medical schools have the recruiting process all wrong.”  

Apparently med schools should be selecting future doctors on the basis of “critical thinking, entrepreneurship, and empathy.”  Dr. Klasko wants more creative collaboration to take the place of stodgy old cutthroat competition that has been a hallmark of modern medical education (or so I heard, as my modest efforts never threatened any of the gunners headed off to become neurosurgeons and dermatologists).  My medical school a generation ago had a several-decades old reputation for seeking the less-traditional student of more varied experience, which played well for myself, and really did give us a cool class of broad experiences and perspectives.  So I’m hip to Klasko’s point…to a point.

 He wants “emotional intelligence” to be at the fore, a varied-background “people-person” persona in preference to the bookish, anti-social med student norm of yore.  The article highlights an emergency doc Bon Ku who “graduated with a degree in classics and was terrible at math,” who likes to train his students in design thinking, which also sounds pretty cool.

 But there are warning signs, too.  “Yale and Stanford are offering art appreciation courses alongside traditional subjects like pathology and microbiology.”  But honestly, unless those are topics covered during USMLE Boards Part 1, studying them would cut into workout and drinking hours, and therefore counter-productive.  They trotted this idea out at my medical school too, and it seemed really cool until I looked at the volume of the mandatory coursework that semester – and lost all interest.

 It makes me leery that academia is always trying to dress up old thinking as new:  “Students in humanities have proven to be just as successful as those with a science background, and (wait for it) they’re more likely to choose primary care or psychiatry as a specialty, which are both areas facing shortages.”  Trying to burnish their PriCare cred, medical schools may want the extra acclaim (and funding?) that goes with pushing primary care on students supposedly more capable of creative problem solving, which creates its own dichotomy.  

 Ku predicts that artificial intelligence will assume a more prominent role, and Klasko wants to free up doctors to spend more time listening to their patients.

 Patients, the media, and academia all yammer about wanting doctors to spend more time listening to patients, but practically none of those patients want to actually pay for it.  They are thrilled apparently to pay for all the point-and-click, core measured, wasteful horseshit that substitutes for actual care, and that will still be the biggest obstacle to this latest round of hopeful touchy-feely. 

 What is more frightening is the onslaught of AI.  I am no Luddite, but this threatens real trouble for the traditional role of physician.  A society already teeming with CVS and Walgreens ‘minute clinics” is going to embrace touchscreen doctoring so fast it will shock us.  Walk in, swipe your debit card, answer symptom questions, and out pops the pill bottle.  Simple.  So simple and cheap that Big Insurance will love it, hire a slew of nurse-doctors to keep them updated to the latest core quality, and re-train population expectations.  Employers will like it, as Big Insurance gives them better rates, and it will get their workers back on the job more quickly.  Sure, it may take another decade for the robot surgeons to start doing CABG’s, but don’t bet on Medicare-4-All being willing to pay for those by then anyway.  And automated squirt of contrast dye, and the AI will read your angiogram and give best odds treatment.  Of course “best odds” for whom exactly will be the question.

 I like the notion of medical students that are conversant, interesting, personable, and able to adapt quickly and solve problems.  I just don’t think that is what the average customer, and certainly not the average payer, will be seeking.  We can bet that none of these academicians will be encouraging their critical thinking protégés to apply any design thinking to moving treatment away from collective patterns, and towards returning medicine to the individual experience.  In fairness to this article, I’d be all for medical schools recruiting on the basis of humor, rebelliousness, and cynicism regarding modern health care.  Teach students medicine combined with modern tech and challenge them to use critical design to thrive independent of big hospitals and third party payers.

 Klasko says, “At some point, the real bar should be whether or not you can actually listen to patients and talk to them.”  Sure it will.  And that will be the function of the kiosk medical professional behind the cash register.

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