ruminations on the future of medicine
There is no repeatable formula for innovation. However, one prerequisite that I’m certain of is the existence of inventors. Now, this is a pretty ill-defined group of individuals, but my intuition tells me that for all their wonderful variety, they hold two traits in common; curiosity and obsession. From this, one can subsequently produce a litmus-test for different fields and measure the extent to which they promote those two traits within the people working in them.
Applying our methods to the domain of medicine, it appears to me that the current institutions do not cultivate the qualities necessary for innovation within individuals. As a result the innovation that we will see won’t come from clinicians working in the system, but from unconventional outsiders.
This is the confluence of a few decade-old trends.
trends
First, let’s consider the selection of the individuals who are put through 10+ years of schooling to attain the highest expertise in their chosen discipline. Ahem, I don’t think the medical school system actually selects for the raw obsession and curiosity needed to drive actual progress in the medical field. Look at our top institutions and the individuals produced from them. Most of them are working on more equitable social health outcomes and marginal improvements to patient care. Maybe there are young, crazy innovators in the medical field, I just can’t seem to find any.
What about the current state of working doctors?
New doctors simply have not put in enough time to develop a competency and intuition that rivals the previous generation. This is partly due to the fact that excessive resident hours have been curtailed, and most new entrants now prioritize a balanced lifestyle. In addition, the drive from insurance companies to squeeze the numerous afflictions of the human body and their respective treatments into a sort of “checkbox medicine” impedes critical thinking and a deep engagement with the very gaps in our knowledge of medicine. Clinical experience is vital for medical breakthroughs and is part of the reason why many radical medical breakthroughs in the past were physician-led.
ok so what?
My guess is that we will see great strides in fields where clinical experience isn’t as necessary, like drug development or therapeutic discovery, but when it comes to actually treating physical, time-sensitive injuries through surgical intervention progress will have to come from outside the hospital. In part, we will see how necessary skilled-clinicians are to the medical innovation pipeline. In the 20th century, many revolutionary medical advances came from physicians who combined deep clinical experience with innovative thinking; consider the history of arthroscopy. Breakthroughs like that emerged not from systematic research programs but from creative practitioners noticing patterns in their daily work. More recent developments in robotic microsurgery suggest that the future of medical innovation will not be physician-led.