Lawrence Weed

A culture of denail subverts the healthc are system from its foundation. The foundation—the basis for deciding what care each patient individually needs—is connecting patient data to medical knowledge. That foundation, and the processes of cre resting upon it, are built by the fallible minds of physicians.

Euphemistically termed “clinical judgment,” physician thought processes cause a fatal voltage drop in transmitting complex knowledge and applying it to patient data. The outcome is that the entire health care enterprise lacks a secure foundation.

Physicians are not equipped to fulfill their immense responsibility safelya nd aeffectively. Other practitioners are not equipped to share that responsibility with physicians. Patients are not equipped to work effedctively with multiple practitioners, nor to assume the ultimate burden of decision making over their own bodies and minds. Third parties are nto equipped to create order out of this chaos. Practitioners and patients are not accountable for their own behaviors, while thir parties re left free to manipulate disorder for their own advantage.

To bring inputs under control, thelegal monopoly of physicians over medical practice msut end, while medical education and credentialing for all practitioners must focus on instilling a core of behavior, not a core of knowledge.

We are all trapped in a non-system, where an elite class of practitioners is permitted to rely on limited personal knowledge and intellect. Graduate medical education and credentialing protect this physician elite from competition that could otherwise reshape medical practice.

The diplomas they grant and the licensing exams the states give could not possibly mean and guarantee what the public thinks they mean.

A similar “complete change” in medical education and practice is needed if we are ever to realize the potential of information technology in medicine. Yet, the prevailing medical culture – and in particular the educational and credentialing institutions that confer legal authority on the physician – remain in denial about the scope of the problem and the wrenching change needed to solve it.

Providers of medical care must shed all the illusions that were bought at such a high price from an antiquated system of medical education and accreditation.

No single provider would need to maintain the illusion of being a “total physician,” nor would the educational system need to support that illusion by requiring students to sweep superficially through and memorize an enormous amount of material at the expense of developing a sense of responsibility and excellence in the activities that they actually perform for patients.

The idea of “my doctor”, the all knowing graduate of a credentialed university medical school must be abandoned.

What the telescope did to expand the horizons of the human eye and thereby increase exponentially our understanding of astronomy, the computer can now do to expand the horizons of the human mind and thereby change the whole field of medicine.

The quotations and associated annotations below may give us insights that will help us accept and get on with the radical changes that must now be made in medical education and medical practice.