January 25, 2013

Shaywich’s Healthcare Trends for 2013, #2: Relentless Standardization of Medicine

On January 22, I discussed Dr. David Shaywich’s first healthcare “tension” for 2013: preventive healthcare vs. excessive medicalization. Today, I want to consider his second healthcare trend for the new year: the relentless standardization of medicine.

The Cheesecake Factory School of Medicine
Shaywich describes a trend he finds alarming: seeing one’s doctor these days resembles going to lunch at the Cheesecake Factory. You go for a reason; you have a brief conversation with the employee, based on a standardized menu of options; the employee feeds your comments into the computer; you get the very same product delivered to you that every person in every other location receives who said essentially the same thing you did to the employee.

Some might say the Cheesecake Factory approach represents progress. There’s a gigantic database of medical info now available; why not rely on it more regularly? There are wacky practitioners out there who act capriciously; why not pull them into the mainstream? There are thousands of studies that point the way to treatment for your symptoms; why not utilize the data and – based on what has worked for the greatest number of patients like you – do the same thing? Our medical history and records are now pretty much computerized; why not plug a few new bits of info – the patient’s latest comments -- into the data, hit “enter,” and act according to the results of the recalculated algorithms. Bingo!

Not quite so fast, Shaywich cautions:
The reality, say many physicians, is so much messier – symptoms are often vague, reasons for the visit are often complex, there is no clearly-defined “best practice,” and the problem to be solved is often so much more nuanced that “what’s wrong with my car." 
And it’s not just the patients who stand to lose if we keep heading in the direction of the Cheesecake Factory school of medicine. He worries about the potential deterioration of the important doctor-patient relationship, and he wonders how thoughtful, creative physicians will begin to view their emerging new professional arena:
I am overwhelmed by a feeling of tragic sadness as I see the pervasive sense of dissatisfaction that has settled over medicine, leaving so many honorable, brilliant, well-intentioned doctors in a near-state of shock, asking whether this could possibly be the profession they had dreamt of all their lives, and worked so hard to enter.
The Irony of Complex, New Medical Information
Here’s the curious paradox in the story of today’s healthcare: the very same specificity of new, digitized information that makes the Cheesecake Factory approach possible, also makes possible another new type of ultra-personalized medicine. We’ve plotted the human genome; we now have the ability to target particular genes that control our health or predispose us to particular illnesses. Science now provides us with an ability to make the practice of medicine – or at least the treatment of specific conditions at this time – completely personalized in a way unknown to healthcare professionals just a few years ago. And what we’ll learn in the next few years will surely astound doctors practicing today.

So… are we off to the Cheesecake Factory, or somewhere else?

1 comment:

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