In The Innovator’s Prescription Clayton Christensen details how technology is disrupting health care. He describes the provision of medical care as occurring on a spectrum ranging from intuitive medicine to precision medicine. Intuitive medicine is care for conditions loosely diagnosed by symptoms and treated with therapies of unclear efficacy. Precision medicine is the delivery of care for diseases that can be precisely diagnosed and with predictable, evidence-based treatments. Intuitive medicine is almost entirely dependent upon clinical judgment. Precision medicine not as much. 19th century medicine was intuitive; the 21st century will prove precise.
When we think about our role as doctors, we like to see ourselves as providers of intuitive medicine. It’s how we were all trained – products of 20th century mentoring. And so we see of ourselves just as indispensable as we were 100 years ago. But as medicine makes its march toward predictive care all of this will change.
There’s an endemic insecurity among the 21st century doctors: we want the precision that technology brings while at once proving that we can still do it all with our hands. So many are fighting to keep medicine intuitive – it keeps us relevant. Artificial intelligence, after all, doesn’t do intuition like we can. For now anyway.
Stay tuned as the 21st century unfolds.
(The links to The Innovator’s Prescription represent affiliate links.)
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“The 19th century medicine was intuitive; the 21st century will prove precise.”
Although I agree that technology will continue to provide “precision,” medicine will never be “precise” for the simple reason humans aren’t precise.
While technology continues to perform left brain task better than humans using sophisticated software, the right brain will always be needed (intuition, wisdom, experience) to connect the dots.
Ideally, we’d want both… precise intuition. Right? Why have them mutually exclusive?
While humans clearly aren’t precise, their diseases are becoming increasingly so. Things that we never believed could be quantified can now be measured. Advances in areas like nanotechnology will alter things in ways that we can’t even imagine. The role of the doctor will be very, very different a generation from now.
I’m re-reading Innovator’s Prescription as we speak!
I love this breakdown. It parallels Atul Gawande in The Checklist Manifesto. Gawande says that lots of docs want the swagger of the original test pilot who flew by feel, as opposed to the precise, group effort experienced by modern airplane crews.
Should we be protecting a guild, or handing out the keys to the kingdom to the patients?
I’d weigh in, but I Googled myself recently and was shocked to find that all my comments on blog posts came up….
Perhaps we can split the difference and share the keys to The Guild.
Interesting about comments and search. I’m apt to be more ‘loose’ in my dialog when commenting. Interesting implications for med students, perhaps.
Nice. You’ve described something I’ve been trying to put a finger on.
“Cook book medicine!” is the catch-phrase of those who see dwindling need for their intuition and feel less valuable. If they could only see the value in becoming the champions of evidence-based medicine.
Of note, the more precise CT becomes, the more intuitive a surgeon must be. We now constantly see “pathology” (free air, intussusception) which were no-brainer trips to the OR in the past. But with high-resolution imaging, we now see errant bubbles in patients whose symptoms barely merit a CT, much less a trip to the OR. And we’re back to intuition.
Good point, Chris. And we’ve also learned that children with acute gastroenteritis have bowel wall thickening that can look just like crohn’s disease.
We either need better imaging or fewer images.
Thank you for pointing out the inherent tension that exists whenever any disruptive technology starts to simplify a service or skill to the point where the expert’s capabilities can be transferred to someone else. There is a passive-aggressive-like tendency for intuitive experts (doctors are not unique in this regard) to demand the development of these tools that make their lives easier, yet disparage them should they feel threatened with disruption and obsolescence.
My conclusion is this: it’s next to impossible to convince experts that “deskilling” precision tools can ever replace what they do, could remotely substitute for their years of training, or possibly hope to replicate their years of experience. Instead, the most receptive users of precision tools are always the *non-experts* — who are relieved of the need to wait in line, drive long distances, pay exorbitant fees, acquire a referral, request a co-signature, or overcome any number of other obstacles we’ve put in place in order to preserve the exclusivity, power, and authority of The Guild. What disruptive technologies have done to industry after industry is to demonstrate the futility of insisting that the activities of today’s experts will always be things that only the experts can do.
That said, we’ll always need intuitive experts in health care, because there will always be new and evolving diseases to work on. That’s precisely [sic] where we should want them to focus their talents. But when there are tools that allow us to deliver precision care in less-costly venues via less-costly caregivers, we must do that as well. It’s a difficult challenge, but I encourage my fellow physicians to explore how they can use precision tools not just to help themselves, but to empower others on their care-giving teams to do more. The most successful physicians of the future will indeed be very different — managers of people as much as they are managers of health. Those that insist instead on making futile attempts to defend their turf and who refuse to adapt to a changing competitive environment will indeed be the first to realize their fears of obsolescence.
Dr. Hwang,
I love it.
I’m in the process of developing a pitch for why medical innovators should take these ideas into account.
How do I support the idea that the time for these disruptions is now? I get it that the sooner the better, but can you provide some indication that these disruptions are on the near horizon?
-Aaron