Doctors of the Future?

>> Wednesday, December 1, 2010

I’ve been following the very active twitter stream of Dr. Victor Montori, who heads up the SPARC innovations and design lab at the Mayo clinic (HT @ryandrumwright). At Mayo he leads a team working to improve patient care through design (my words – not theirs).

Their work is centered on a philosophy that may well change the way medicine has been practiced for the last several hundred years.

Until recently, doctors have focused on making measurable improvements in the illness they are treating. If you have multiple sclerosis, your neurologist measures her success by her ability to control the spread of lesions that can be seen when they scan your brain. If you have diabetes, your endocrinologist does her best to ensure that your A1C levels stay within a certain level.

This focus on measurable outcomes has created a revolution in life expectancy. In the short time between 1900 and 1985, life expectancy went from 30 years to 62 years – an astronomical jump.

But our progress has slowed, and increasingly doctors find themselves frustrated by their inability to make measurable improvements in the diseases they treat. The #1 culprit in this trend is people -- millions of whom ignore their doctors’ orders. We don’t take medication we've been prescribed, eat foods we shouldn't, and generally do anything and everything to frustrate our doctors’ desire for us to get better.

We here at Wellness see this dynamic every day. That’s why Dr. Montori’s work is so important and fascinating.

He is one of a growing number of voices from the medical community who are advocating for a wholehearted reexamination of priorities. By crowning measurable improvement as the central tenet of modern medicine, we have created an antagonistic relationship between doctors who want to make the human body work better and patients whose priorities are often more about living well in the time that they have.

Yes, someone living with diabetes would have better blood sugar control if they adhered to a strict diet and exercise regimen. But for many people, this would be a worse fate than suffering from the symptoms of uncontrolled diabetes.

At the heart of everything is a very personal decision about what makes life worth living.

Dr. Montori, and those like him, suggest that we should put this personal decision at the heart of every medical interaction. -- and that doctors learn to first understand what is important to their patient, and then design a care plan around those priorities.

He calls it Minimally Disruptive Medicine. I call it the wave of the future.

If you’d like to read a moving personal narrative from a physician struggling with this issue in his personal practice, check out this piece in the LA Times by Steve Dudley.

Hope this finds you well,

Jacob Braude

VP, Strategic Planner


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