While most of us fail to see it, but doctors are changing. We’re changing as a result of the social and technological innovation. In 2050 what we do and how we do it will be very different from what we did at the turn of the century. We’re evolving from analog to digital. I think it’s important to consider the ‘digital physician’ as a concept worthy of attention. The training and support of this emerging prototype has to meet its different needs and workflows. Perhaps the criteria by which we choose medical students should take into consideration the anticipated skill sets and demands of this next generation. And we need hard information about the digital physician and her habits.
Here are some differences between the digital and analog physician:
The digital physician
- Information consumption is web-based
- Rarely uses a pen. Care and correspondence is conducted through an EMR.
- Socially connected. Comfortable with real time dialog at least on a peer-to-peer level. Recognizes the inevitable role of synchronous digital dialog between doctor and patient.
- E-patient centric. Recognizes the sovereignty of the patient and recognizes their access to information as a critical asset to care.
- Mobile dependent. Sees the ability to provide patient care as dependent upon a smart phone or tablet.
- Uses digital tools to control inputs. Has web-based mechanisms in place to help curate information and other inputs from various sources.
The analog physician
- Consumes information through paper books and journals. Often overheard saying curious things like, “I like the smell of paper” or “I’ve gotta be able to hold it.”
- Still use paper charts. While she may interface with computers, her care is coordinated and facilitate via the manual exchange of ink on pulp. Illegible prescriptions are seen as a badge of honor.
- Has little to no social presence. Either doesn’t understand the value of engagement or is driven by fear. Sees no obligation to participate in social dialog or content creation.
- Physician centric. Sees physician as the core provider of information. Care delivery centered as much on the needs and demands of the physician as the patient.
- Smart phone has no real role in her provision of care. Even the simplest point of care queries are done through dog-eared manuals kicking around the work area. May be overheard lamenting AT&T’s discontinued support the Motorola StarTac.
- Core inputs are snail mail box and email. Can be heard giggling, “If it’s not in my ‘in box’ I’ll never see it.”
This transition is happening to very slowly and most of us remain analog doctors in a digital world. But that won’t last. The natives are arriving. In July I met my first intern who had never worked in a paper chart. Are you digital or analog? What else defines the digital physician?
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This is really a great piece about the state of culture change happening in medicine from the physician point of view. The bottom line is that the focus is changing from physician-centric healthcare to patient-centric healthcare which in my opinion (as both a patient and a doctor) is a GREAT thing! So glad that the new Affordable Care Act changes in incentives (ACOs, CMS Innovation Center, Pay For Performance, HITECH act) supports this transition.
And the disconnect between born-digital medical students and the analog faculty who train them is becoming an ever wider gulf. Although the analog physician may conjure nostalgic images of the old-fashioned doctor, I wonder if digital doctors actually provide better care? Are their patients happier and healthier? My guess is yes, but what will it take to get the traditional medical institutions to value and reward these new skills?
Excellent points, Kirsten. I suspect if we were able to conduct a real comparison we would find that analog to digital has clear tradeoffs. Not sure it’s better or worse, just different. I believe that the analog mentor issue is a big problem that we simply don’t want to recognize.
We need someone to raise these issues ; )
I love your analogy! But I would also paint a middle ground, where I feel like a digital doctor trapped in an analog cage. The environment (infrastructure, resources, facilities) constrains a doctor’s ability to engage patients in more innovative and dynamic ways!
Doctors, similarly to other professions that have been empowered by emerging technology, will need to adapt to survive. Digital consumers (epatients) will increasingly expect their health life to look and feel like the rest of their life – easy & structured to meet their needs. We will know that health 2.0 is here when the terms digital doctor, epatient, mhealth, etc are no longer needed…
@Pjmachado
This post is so well done! You sum up perfectly thoughts I often have. Outside of my clinical duties at work I am also in an administrative role responsible for promoting the use of many online tools for patient care. The divide between the analogMD resistance and the digitalMD excitement is a gulf that is hard to navigate.
This line is especially well crafted: “E-patient centric. Recognizes the sovereignty of the patient and recognizes their access to information as a critical asset to care.” However, I disagree that the analogMD is therefore the opposite – MD centric. I believe instead that they are by nature, by basic personality type slow to adapt to and fearful of the new opportunities around them. This makes them miss out on opportunities for improved care. Our challenge is how to help them move forward with the shifting paradigm.
If I’m reading this correctly, Bryan makes no value judgements here – these are just descriptions of docs in two pigeon holes on either side of a broad spectrum.
Fortunately the savvy “patient-centric” physician can and does extract what he needs from both sides of the fence. His eyes are focused on his patient and how he can meet their needs and wants.
Most of the true Luddite physicians will never know what hit them when their practices slowly wither.
However, the current majority of patients who arrive in our offices are not impressed by seeing their physician pecking away at his tablet or iPad instead of listening intently during the visit.
I think that PCPs and docs who have more “guideline-based” practices will be earlier adopters of fully digitized medicine.
Fortunately, the idea that a physician’s ability to care for patients is dependent upon digital technology (cloud-based intelligence, online collection of patient data, EMR-based practice) is too constraining to most docs. The majority of physicians still want the “art” side of medicine to be appreciated (and reimbursed) by patients.
Whether that is a Pollyannish fantasy remains to be seen…
I was at Connected Health Symposium in Boston where a few docs were already discussing what will happen to their colleagues that do not adopt technology… patients will stop seeing them.
Indeed, Simon. We’re not far from seeing market forces changing physician behavior.
I agree that it is paramount for us to support and welcome this positive disruptive evolution of the doctor. The habits of the now arrived digital physician are built for speed of communication and will naturally transform inefficient workflows. Today’s technology clearly facilitates this. The traditional medical selection and training environment does not. I wonder if the digital physician will soon force a change in the healthcare payment model as well. Especially witnessing the frame shift in consumer behavior by the digital native.
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