The Rise of Medicine’s Creative Class

LightbulbAre we witnessing the rise of a creative class in medicine?

The creative class in medicine may be seen as a key driving force for change in a post-analog era.  They are the disruptors willing to poke the box.  The reason that this emerging segment of health care providers is so remarkable is that medicine typically punishes creativity.  In medicine, makers make at significant professional risk.

The creative class in medicine is facilitated by the democratized tools for writing, recording, photographing, making and publishing.  Anyone with an internet connection and a good idea can have a talk show.  Everywhere I turn I see docs making things.  This weekend Joyce Lee collected a bunch of makers and tinkerers at the University of Michigan for We Make Health Fest.  FOAM has evolved beyond a global movement to a mindset about education.  Digital provocateur Larry Chu and the thinkers at Stanford’s Medicine X have driven a new conversation about patients and medicine.  Look under the hood and you’ll see that Medicine X is driven by medicine’s creative class.

Quite predictably, not everyone likes it.  All this free thinking, sharing, making, and generalized lack of lockstep order makes some of us just a little bit uncomfortable.  But uncomfortable is good.  We all need to get a lot more uncomfortable.  We don’t have a choice.

It’s no longer 1954.  But there’s an unexplainable high to seeing 400 years of a stagnant profession turned over like rotting compost. With that said, I suspect that somewhere William Osler is smiling.

Ayn Rand had words that I’m sure were intended for those members of medicine’s creative class intent on drawing the map for the next generation of medicine, “The question isn’t who is going to let me, it’s who is going to stop me?

Lockstep Medicine

Auburn_lockstepIn medicine it seems ..

We idolize leadership but promote management.

We marginalize vision while rewarding process.

We worship list makers.

We’re trained as responders not initiators.

We propagate a culture of permission and seek to breed a generation precisely like the last.

We believe that thought leadership and the transmission of ideas happens on an 17th century communication platform.

Wes Fisher has it right this week on Kevin MD when he asks, ‘What kind of doctor are we breeding?

And what kind of leaders are we creating?

Image via Wikipedia

Medical Leaders will Think Out Loud

Leaders think 33charts

The public space is where knowledge, information and conversation now collide.  It’s where we should be.  The evolution of our profession in a networked world must involve attention to how we think and share in the great wide open.

In fact, a defining feature of a leader in the digital age will be the capacity and will to look beyond what they can see and touch.

(This is my first stab at a graphiquote (not sure what you call this…just made it up).  We’ll see how it takes.  Feel free to share and share alike.)

ReelDx – Video Learning for the Digital Age

We’re excited to have ReelDx as a sponsor of 33 charts.

ReelDxI remember as a pediatric resident studying the famed Zitelli Atlas of Pediatric Diagnosis to understand how disease looked.  Rashes and physical findings were best understood visually.

We still learn by seeing.  But what we look at has evolved.  New, networked media represent the next iteration of the glossy atlas.  Textbooks are giving way to applications and dynamic content platforms that can grow and adapt almost in real time.  The modern medical learner is consuming and acquiring knowledge with new media.

reeldxreeldxreeldxI had the chance to play with one platform making a move in this area, ReelDx.

What is ReelDx?

ReelDx is a video learning library of real patient encounters recorded in actual clinical settings.  The case writeups are brief, focused, direct, and visual.  Beyond the videos, which tend to run 1-2 minutes, the clip is associated with other elements of the patient’s story including medications, past history, etc. Many cases include diagnostic imaging and other test results.  Curated links take the learner to supporting content around the subject matter.

The interface is intuitive and uncluttered.  Cases are produced and peer-reviewed by credentialed MDs.  This is definitely not YouTube.  Think of it as an academic journal brought to visual life.

Currently ReelDx offers video libraries in pediatrics and emergency medicine.  While the ReelDx library in pediatrics offers cases of all varieties, I found myself gravitating toward dermatology cases (I’m terrible with rashes). There’s something about seeing real patients with skin eruptions – from hives to HSP – that really makes stuff stick.

The power: videos in context

For me, ReelDx’s power comes from a video case delivered in the proper context.  Where I’m going here is that ReelDx delivers a case within a broader context.  The democratization of media has allowed the development of tools that lower the threshold for sharing.  Showing a picture or clip is one thing.  However, showing a clip in the context of history, final diagnosis, treatment and supporting references is where the money is.

More exciting than what ReelDx offers to learners is its potential for the future. As an educator I’d love to see analytics surrounding learner use.  How long do they spend there?  What links do they use?  I’d like to see an option for assessment. Community features that allow users to comment on and exchange ideas about a case might add real value.

It also might be an interesting option to hear more of the patient’s narrative.  A 2-minute clip sharing the patient experience might be powerful.

In sum, while teaching by video isn’t necessarily new, ReelDx is the first platform to do it in well in this emerging multimedia space.  While positioned as a video library, I might go wider and see it as an information exchange platform for the modern physician and patient.  Platforms and applications like ReelDx represent the learning media of the 21st century.

ReelDx is currently available for individual subscription as well as institutional licensing.. Their cases are filmed by contributors at organizations such as Yale, Johns Hopkins, University of Louisville and Oregon Health & Science University.

You can give it a try here.  Let me know what you think.

Can I Deliver Your Presentation?

1962 2Recently one of my colleagues called and asked if she could borrow and deliver one of my presentations.  Apparently she had been called on to give a talk on new communication tools in medicine.

‘Delivering’ someone else’s presentation makes no sense.  It’s like borrowing somebody’s comfortable shoes.  You can do it but you’ll likely feel funny.  If the crowd is smart, they’ll notice that you’re walking differently.

The better question to ask:  How do you structure your presentation for doctors new to social media?  Then it makes sense to take my deck, study it and build your own.

To deliver an angle and sequence other than your own is to sell yourself and your audience short.

And no one likes to lend their comfortable shoes.

Slide, circa 1965, courtesy of Richard Vartabedian


Do You Initiate or Respond?

StartButtonSeveral years ago Seth Godin wrote about our modes of daily operation which center around response and initiation.  It’s interesting to look at medicine from this perspective.

In medicine we are all about about response.  At our core, we respond to disease.  On a more granular level we respond to pages, abnormal lab results, and new symptoms in our patients.  We do things when people give us things to do something about.  We get pretty good at this during our training.  Residency is all about responding to throughput.  We learn pretty quickly that the brightest residents are the ones who show up early and check off all their boxes.  We are taught to manage patients.  But managers respond, leaders initiate.

But doctors rarely initiate things.  We don’t see ourselves as leaders.  Probably because we’ve never been trained to start anything.  We walk in lock-step.  Medicine is a permission-based culture.

Of course no one wants a creative anesthesiologist (you may, but that’s another post).  But at some point somewhere, someone has to begin something different.  Checklists have always been important in medicine.  But there have to be those who think about new ways to see the checklist.  At some point the list had to be created, updated and questioned.

More than any time in history this generation of will need doctors with the capacity to break ground.  The Creative Destruction of Medicine isn’t going to go well without professionals who think about how we’re going to put all this technology to good use.

Chris Brogan this morning also wrote about starting.  It’s worth a peek.

Medicine’s Emerging Digital Culture

I suspect that we’ll see a real digital culture emerge surrounding doctors and medicine.  One centered on a new mindset and workflow, created with new tools.  At one point we were only seen in fluorescent lit offices with stethoscopes.  The AMA and the public affairs messengers in our local hospital decided what we understood about doctors.

Not any more.  We are all publishers.  The world sees us for what we are.  Fertile, brilliant, edgy and human in the way we think about health and medicine.  Everything you understand about what we do and how we can get it done will be different.  New tools and a new set of platforms will define us.

Look at Matt & Mike of Ultrasound Podcast.  A space for ER ultrasound, they build, create and ideate, with an unrestrained flair.  Audio, e-books and, human jpgs, and real writing showcase a new place to center a medical conversation for this corner of medicine.  This is not institutional medicine.  While young academics, what they do is not academics by traditional measures.  This is not ‘private practice.’  Those are one dimensional 20th century views of who we are and what we’re capable of.

This nascent digital culture is invisible to the analog majority stuck at web 1.0 with the belief that email is the killer app.  While what we can do and make is nearly unlimited, the majority among us complain about all that they can’t do and all that the system won’t give them.  Soon these tired souls will serve as a cautionary tale.

“But how do we get doctors to change?” you whine.  As Esther Dyson suggested at Medicine X a few weeks ago, the progress of medicine will happen one retirement at a time.

Technology has created the foundation.  A spirit to build and create with amazing tools will complete the act.

This couldn’t have happened at any other point in time.

Medical Leaders in an Idea Economy

I was at a meeting not long ago where I had dinner with two rising stars of the pediatric world.  The conversation drifted into the dodgy territory of international journals they had found which were willing to publish less-than-stellar research.  One advised the other how to make two weaker publications where there was one.

Our meeting lacked intellectual energy.  There was no spark of fresh concepts or new perspectives.  Little passion, just process.  Sleight of hand for self-promotion and the mass production of peer-reviewed widgets.

These are the medical leaders of tomorrow.  Or are they?

In medicine we’re trapped in a system that values laundry lists over ideas.  But we need to think about what we value.  In the knowledge economy, ideas are the new commodity.  Steven Johnson tells us that the most innovative ideas throughout history have resulted from networks of creative people collaborating and challenging one another to explore the adjacent possible.  It’s how we begin to solve problems.  Peter Diamandis has it right in his book, Abundance: “In a rapidly changing technological culture and an ever-growing information-based economy, creative ideas are the ultimate resource.”

While we are likely to remain preoccupied with lengthy lists, the medical leader of tomorrow will trade globally in the currency of ideas.

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Why Vinod Khosla is Right

Recently Vinod Khosla, founder of Sun Microsystems, keynoted Rock Health’s Health Innovation Summit where he offered a bleak outlook on the future of the MD.  David Shaywitz at Forbes has some interesting commentary that’s worth a peek.  Davis Liu and Venture Beat’s Matt Marshall offered nice reviews.  Khosla’s Techcrunch piece, Do We Need Doctors or Algorithms, is required reading for anyone with a lens on the future.

Khosla’s recent views on medicine were best summarized by Shaywitz and are as follows (not verbatim):

  1. Medicine needs disruption.
  2. Entrepreneurs focused on consumers are most likely to disrupt.
  3. Since doctors are part of the system that is the problem, they’re not likely to create the solutions.
  4. In the near future, computer algorithms may well replace doctors (80%).

Despite predictable indignation from the medical community, Khosla’s vision isn’t far off the mark. Much of what we once did with our eyes, ears and hands will be replaced by diagnostic and predictive technology.  This is already happening.  The older generation doesn’t want to believe it.  The millennials don’t know anything else.  I might add, however, that I prefer to position the physician’s future as marked by radical redefinition rather than outright displacement.

I do have issue with the growing belief that physicians lack the capacity to participate in shaping or envisioning the future of health.  Our profession is undergoing what may be its most dramatic change in modern history.  I’m confident that a new generation of medical leaders will emerge that will counter current assumptions about doctors and change.

Khosla’s a remarkable guy with some provocative ideas.  I regret that I wasn’t in the Rock Health audience when he challenged physicians to counter his assertions – not because I disagree but because this subject is in need of visible dialog.  My greater regret is that his challenge was met with silence.

And that tells me either everyone’s on board with Vinod Khosla, or there’s truly no hope for our future.

Doctors and the Price of Political Commentary

This week I came across politically charged tweet from a noted physician author.  It was a caustic commentary on one of the presidential candidates.  I’ve seen this a lot recently: smart doctors wading into the cesspool of real-time political discourse.  Frustrated pundits believing they’ll sway opinion in 140 characters.  It got me thinking about political opinions and the physician’s public presence.  The two don’t always mix.

In this case, my relationship with the author is one of fantasy.  When I read his books I engage in a type of fantasy about medicine and its broader place in the world.  While he may not understand it, this fantasy is an unspoken arrangement of the quiet relationship I share with his voice and ideas.  Social transparency can come with the risk of readers understanding too much.  And like so many authors that I read, mystery fuels the fantasy.

Of course, this fantasy issue is as much my problem as anyone else’s.  Those who choose to listen to dialog must be willing to process what comes through.  Transparency is subjective and defined by our individual values.  Listening comes with its own responsibilities.

But independent of how much responsibility we choose to give our audience, public comments need to take into consideration how we’re perceived by those who listen.  Hard-edged political commentary in today’s climate comes with the risk of alienating half of your platform.

This may be more important if you’re in the business of asking people to buy your book, read your blog or trust you with their life.

Can Students Learn Medicine by Looking at Art?

This WGBH piece on Harvard Medical School’s Training the Eye course is worth a peek.  Training the Eye is a preclinical course designed with the intent of developing aesthetic skills that can be applied in the clinical setting. It’s the brainchild of Alexa Miller, a Boston-based art educator.  You can read about her fascinating approach to teaching visualization here.

So what makes us think that we can teach medicine by looking at art?  The numbers of those who have sought to measure it.  Museum field trips are a legitimate educational tool because there are associated metrics.  Students who complete Training the Eye are able to make 40% more clinical observations than other students.  Then there’s the extrapolation that these doctors will make better decisions.

I need to know more here.  Tell me what it is to ‘learn medicine’ and then we have someplace to start.  And the medicine applied and practiced in just 10 years can barely be imagined by those charged with creating today’s curriculum.

And I have to wonder if we can we learn medicine by:

  • Reading widely
  • Writing reflectively
  • Playing with Legos
  • Being a patient with a chronic disease
  • Maintaining powerful personal relationships.
  • Failing at relationships
  • Spending a significant amount of time living in another culture
  • Cultivating spirituality
  • Learn to play a new musical as an adult
  • Standing by during the final moments of a friends life

What parts of the human experience belong as structured, measureable elements of medical education?

Museums are amazing.  Art can have remarkable effects that impact the way we see the world and relate to people.  I just wonder if measuring the abstract elements of the human experience may be the wrong approach in validating this kind of visual literacy.  But this is the problem of a system that demands numbers and pie charts, not one of Alex Miller’s unique efforts to move the chains forward.

Perhaps we should just admit that the medium of art and broader life experiences create doctors with balance and equanimity.  And some things just can’t be measured.

(Note to self: put Alexa Miller on my list people to have to dinner.)