Medicine and The Access Effect

June 18, 2014

IMG_3626I overheard on Twitter last week that there are institutions that don’t allow the use of smart phones by physicians.  It seemed hard to believe.

Then it made sense.  Because we’re in transition between siloed and networked worlds.

Our siloed world supports encounters with the health system that are isolated, episodic and dependent upon the capacity of a single provider.  A networked medical world operates in real-time and is supported by decision-making intelligence that extends beyond what one person can offer.

Modern medical work is rooted in the analog.  So doctors without phones, tablets or even computers do just fine.  Their work requires little in the way of access.  Many are modern-day empiricists doing what has been done for a few hundred years: evaluating patterns, applying intuition based on personal experience, and delivering therapies based on what’s been proven for swaths of people.

For advancing medical fields dependent upon precision diagnostics and therapeutics, a world supported by personal judgment alone won’t be sustainable.  Consequently, doctors will be unable to work without access to mobile tools of information, communication, and diagnosis (connected tablets, smartphones, and glass).

While our current ability to connect the right information to our clinical encounters is primitive at best, this will evolve.  And handheld or brow worn appliances will represent required elements of the physician’s expanding outboard brain.

Sure, there’s lots doctors  know.  But there’s more they don’t know.  This is the first generation of doctors who, instead of memorizing, will access what they need to know.  And as the crisis of information escalates, this access effect will become more apparent.

For now, however, some hospitals feel that doctors are better off disconnected and intuitive.  And for a medical world still entrenched in the analog, this works just fine.

The image is one that I took in The Long Room of The Old Library at Trinity College, Dublin.


Emily Gibson, M.D. June 18, 2014 at 8:11 am

Dr. V,

This is a crucial analysis of how we physicians now make clinical decisions, whether in isolation using memory and empirical experience, or whether in a broader network accessing evidence based data. Over the thirty plus years I’ve been in the profession as a primary care physician, I know my increasing ability to instantly access and analyze information that is available outside of my memory and experience is crucial to the care of my patient.

As I embark on the long slog of preparation for my sixth and likely final Board recertification exam in three years, I question how memorization and manipulation of details and facts truly tests the clinical competency of the modern physician. Physicians should no longer be measured using the same primitive yardstick.

Enjoyed seeing your photo of The Long Room at Trinity College!. It was one of the most remarkable and humbling man-created places I’ve ever visited, realizing the knowledge stored in those thousands of volumes is literally available to me with a point and click.

DrV June 18, 2014 at 8:49 am

Thanks, Emily. We’re in the midst of a remarkable transition in the way doctors think, work and care. So much to consider.

I’m thrilled that you’ve been to The Long Room. I could have just sat there for hours looking around. Agreed…awe inspiring.

Adam Nally, D.O. June 18, 2014 at 12:29 pm

So Very True!
“Modern-day empiricists” . . . love it!

Kipp Ellsworth, MS, RD, CSP, CNSC June 19, 2014 at 12:44 pm

Dr. V:

Once again, your commentary perfectly encapsulates the struggles clinicians face as they attempt to incorporate social media tools into their practice. Nutrition support practitioners remain largely confined to the analog arena, using their clinical instincts to assess, monitor, and evaluate their patients. Fortunately, the incipient metagenomics revolution and its attendant bevy of data will hopefully sunder institutional silos as clinicians rush to achieve a better synergy between their analog tool kit and the incorporation of clinical informatics. In particular, nutrition support practitioners will have to adopt an “access” mentality as they increasingly individualize their assessment and evaluation of patients using the latest nutrigenomics and metabolomics research. I look forward to the promise of achieving this synergy utilizing the latest informatics tools and certainly look forward to reading your future posts.

Hope to meet you at the annual NASPGHAN meeting in Atlanta in October.

Kipp Ellsworth, MS, RD, CSP, CNSC
Children’s Healthcare of Atlanta

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