Mixed feelings about training system-based physicians

Your October editorial titled "Training system-based physicians" (Contemporary OB/GYN. 2011;56[10]:8-12) evoked some mixed reactions. Although I agree with many of your comments, I was disappointed in the black-and-white image you paint for your students and because nowhere in your address do you mention the humanistic aspect of medicine. Words such as "caring for," "empathy," "sympathy," and "compassion" are conspicuously absent.

In the golden age of medicine, when we illegibly scribbled on paper charts, we actually spoke with and touched our patients. Despite the fact that we thought that the diploid number of chromosomes was 48, that smegma caused cervical cancer, that sonar detected submarines, and that sacrificing rabbits was necessary to diagnose pregnancy, we actually did care for our patients. Today's patients exist as computer icons. The white coat no longer necessarily represents a knowledgeable, compassionate, competent physician but a knowledgeable, competent, computer-focused automaton. The patients must still know that their doctor cares-not only that he knows.

I agree that system-based physicians will use systems that will virtually eliminate preventable errors and will employ only the latest evidence-based medicine that relentlessly focuses on cost effectiveness, but will they focus on the patient as well as the malady of the patient?

I agree that working long hours diminishes judgment and slows reaction time, but there are times when continuity of care is paramount to long hours. Yes, we should "standardize procedures that work best and eliminate unnecessary variation and cost," but we should remember that we are dealing with biological issues that by their very nature may be variable.

Finally, I am not sure that your students will be the future quarterbacks of the healthcare team. Physicians have lost control of their destiny. As healthcare providers our destiny is in the hands of the politicians and insurance companies. Regaining control will require a little of Captain Kirk and a little of Captain Picard.

IRWIN KERBER, MD
DALLAS, TX

Dr. Lockwood responds:

Thank you for your very thoughtful comments, as well as your good humor. In retrospect, I do realize that memory can be selective. In my editorial, I tended to focus on those behaviors and attitudes that would be in starkest contrast to what is expected today. I did indeed benefit greatly from learning from some very caring and compassionate physicians who felt truly privileged to care for women throughout their lifetimes. Ultimately, I am remiss in not painting a more balanced picture of what medicine was like when I was a student.

I also agree that medicine has already trended toward emulating more of the impersonal aspects of industry, and is often relatively lacking in the human touch. However, this seems to be the direction society as a whole has embraced: medicine as a commodity.

I do disagree with you about your doubts that physicians will be the future quarterbacks of the healthcare team. The main thrust of my message was that attitudes and practices change over time. I firmly believe that the way we as physicians keep control of our destiny is to not focus on the "good old days" and protect the ways of the past, but rather leverage what has been learned in other industries about such things as safety, teamwork, and efficiency, and introduce them into medicine. Whether Picard or Kirk, it will take great leadership to marry the best of the old medicine and the new.

Thanks again for sharing your insights.

CHARLES J. LOCKWOOD, MD, MHCM
EDITOR IN CHIEF