Physicians as Compulsives and Creatives

December 28, 2012

It’s been said that you’d rather have a doctor who’s thorough than brilliant.  The point isn’t that you don’t have to be smart to doctor, it’s just that when it comes to patient care, the compulsive attention to detail will get you further than genius.  This lockstep approach to health maintenance marked the industrial age physician.  We talked, walked, examined and dressed alike.  We were systematic, rigorous, and hierarchical.  It was all we knew.  We were the compulsives.

Surgeons have had their own cultural order.  I had a surgeon teacher in medical school who flaunted  the fact that surgeons ‘did things.’  Hot lights/cold steel for appendicitis.  It’s just how things are done.  Then came the idea that manipulation of the insides could be done through a tiny hole.  Someone had to jump ship and see things differently for that to happen.

Going forward the practical application of advancing technology will require a more open way of thinking about problems.  Of course the 20th century had its creatives and the 21st century will still need compulsives.  But there are diagnostic technologies and patient extenders who can help work the magic.

I just wonder if the next hundred years will call for something very different in a doctor.  Perhaps the future will call for a population of physicians who think and work less in lockstep and more as creators or makers.


William R. Taylor, M.D. December 28, 2012 at 9:54 am

The individualized medication developed via cells that are described in this quote from a recent New York Times article might qualify as 21st Century medicine. “Steinman declared his cells “dendritic,” from the Greek dendron for tree. This was, he intuited, a kind of cell that had never before been characterized and that served as the missing link in the body’s adaptive response to pathogens.”
Thanks for highlighting the need for consciousness raising regarding future medical education. Just as the medications may become more individualized, so might the doctors developing them.

Seth Kelly December 28, 2012 at 10:16 am

Great insight. I think this is coming much sooner than the next 100 years…perhaps the next 10-15? It’s such an exciting time for medicine. I only hope that physicians understand how important it is to rise to meet this challenge and not let others step in to fill the policy/practice gap if, as a profession, they fail to do so.

DrV December 28, 2012 at 3:10 pm

You just captured my raison d’etre in under a hundred words.

I need to write that down somewhere….

Winston Liauw December 28, 2012 at 2:54 pm

I think the real challenge is how to achieve the right combination of both thoroughness and creativity/critical thinking. One current problem I see is, as a trainer of future specialists, is more reliance on formulaic medicine in a manner that reduces rather than enhances overall quality. Electronic decision support may reduce some error and increase others – so we also need to address how much thoroughness comes from the system and how much from the individual practitioner. To use the terms from Kahneman’s book – we are neglecting to train system 1 adequately whilst simultaneously reducing capacity to exploit system 2 in an effective manner.

DrV December 28, 2012 at 3:09 pm

System 1/2 represents a nice analogy. Part of the solution may come from the recognition of solution shops and VAP business as described by Hwang and Christiansen in The Innovator’s Solution. Perhaps we’ll see the emergence of SS and VAP clinics. Hard to see both existing under under the white coat of one provider.

Thanks for your thoughtful comment, Winston.

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