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What Role Should A 21st Century Physician Play?

Some patients in the 21st century approach “modern” healthcare with the same expectations I bring into a deli for lunch:  “I’d like the sinus infection with antibiotics and a note for work, please.” I confess, when seeing such a patient I have occasionally acted on the impulse to ask if they would like fries with their order.  Yet, these patients do have something to teach us about how to be a 21st century physician.

Eighteen years ago while a fourth year medical student I registered for an elective class on the future of computer science in medicine.  This was my first time to see the Internet and I was awed by the vision my instructors had for the future.  They had no idea.

Today, I use a Droid or the phone uses me – the issue is still in doubt. However, during residency I put pen to paper charts and carried a pocketful of bright red metal clips to signal a STAT order on a chart.  We used computers mainly for literature searches and checking lab results; palm still referred solely to the ventral side of one’s hand.

But technology was invading fast.  Shortly after starting my first job in 1996, computers began to be used for direct patient care and I watched two competent physicians choose early retirement over learning computer skills.

This all occurred before I had sent or received my first email.  The advancements over the first years of the new millennium boggle my mind as I look back over a time that saw PDAs, laptops, and cell phones ensconce us in a world colored bluetooth.

So, what role should a 21st century physician play?  Since my phone doesn’t have an app to tell us, I’ll have to find another way to explain myself but I would suggest the answer lies, partly, in a different question.

What kind of patients do we find today?  Three distinct types come to mind.  The first is what I like to think of as Dr.Google, of whom I used as an example earlier.  Dr. Google has searched the Internet, made his own diagnoses, and often decided on his treatment.  Surprisingly, studies have shown that if the search is done right and with a lot of detail, Dr. Google can be right about half the time; sadly, that’s not the worst average out there but I do aim higher for myself. Dr. Google is a challenge to care for and requires some tact (tip: don’t ask about biggie- sizing the visit).

I had the good fortune to meet the second type of patient this morning. He had used technology to inform himself and presented me with specific, pointed and difficult questions to answer. I was able to interpret for him and help him navigate towards his own goals.  We forged a strong partnership in one office visit; this is my favorite type of patient.

The third type of patient can sometimes be identified by their use of a path gnomonic phrase:  “You’re the Doctor.”  This was Dr. Welby’s favorite kind of patient as he used a relationship based on a combination of implicit trust and deferred responsibility in decision making.  Today, use of this phrase more often identifies a desire by the patient to defer responsibility than it would expose a deep faith in our profession.  A 21st century physician will need to assume a leadership or shepherding type of role in helping this third type of patient navigate today’s Health Care landscape.

Today, doctors will encounter patients armed with both good and bad information.   A 21st century physician should be ready to lead, steer, interpret, teach, and help when help is needed because 21st century patients need a guide,  now, more than ever.

In my opinion, a modern physician working as a Guide will see all of this technology for what it is — a useful tool to further the doctor-patient relationship–and when a long day leaves me feeling more like a short-order cook or paranoid lawyer than physician, I’ll download a happy app.


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