You used that word “doctor” and my translator spit out a long sequence of words for Examiner plus Diagnostician plus Treatment Planner plus Surgeon plus Outcome Evaluator plus Student Trainer plus Business Manager. Maybe it’s stuck and spitting out the names of all the professions associated with medicine.
Does anybody know whether this idea is discussed anywhere else? Not being a medical expert myself I am sceptical that this idea is applicable to the full extent that seems to be implied here. It would only work if good feedback loops are established between the professions, so that information can backpropagate when the surgeon discovers that the wrong treatment was chosen and that was due to a wrong diagnosis which was made because the examiner overlooked some symptom. This point made by Petja Ylitalo above seems to be related:
To diagnose well you need to know which things are relevant for treatment, which means learning most of same knowledge as the treater would have. Information transfer between humans is time-taking and lossy, so the Treater would most likely have much less knowledge to base his treatment on than the Diagnoser, leading to increased risks of wrong treatment (for a practical example if the initial diagnosis was wrong, original diagnoser would be in a much better position to notice this when getting more information during treatment than a Treater who did not see the original data).
I do not know what exactly an Outcome Evaluator’s job would be (in most cases patients should be able to evaluate the outcome themselves just fine), but I imagine somebody collecting data on remissions or, depending on the severity of the illness, survival rates and making this information public combined with the most relevant patient characteristics. I think that would be a great way to help doctors improve their skills and to improve patients’ decision making, so I agree that makes sense.
There already is some specialization in medicine. Doctors are not supposed to be experts on everything and radiologists do diagnoses, but (mostly) no treatments. General practitioners often do preliminary diagnoses and send people off to specialists who then do their own diagnosis and treat the disease. In many cases this is all that is needed. The last time I went to see my general practitioner it was because I had clear symptoms of borreliosis. The doctor looked at me, said “Well that looks like borreliosis.”, did a blood test that confirmed this suspicion and prescribed what I understood to be the standard antibiotic against borreliosis. After a few weeks he did a second blood test to see whether the bacteria had gone (they had). I don’t see a need for specialized examiners, diagnosticians, treatment planners or outcome evaluators here, nor for the general practitioners’ profession in general, nor in the emergency room. Furthermore, in these cases splitting up seems unfeasible because the services of general practitioners need to be widely available and cannot fully be carried out online and in the ER time is of the essence, which prohibits the slow communication entailed by this model, although the idea probably makes sense for chronic diseases and cancer. I think orthopaedists often recommend and then perform surgery, which seems clearly bad. It needs to be discussed to what extent encouraging patients to seek second opinions would already help alleviate the problem without reorganizing the whole medical sector.
I think training on the job in general is very useful (I wish I would have got trained on the job instead of studying at uni) and in all fields I would like to see more practitioners becoming teachers. That does not mean that teaching and performing are perfectly correlated and we cannot have some differentiation between teachers and practitioners. Just like not all drivers are driving teachers, but all driving teachers are drivers, all doctor trainers should be or have been practising doctors. I assume/hope that surgical residents perform their first operations under the supervision of somebody who not only knows how to perform the procedure and can advise them, but also can intervene themselves if need be, i.e. under the supervision of a surgeon and not just some sort of surgeon trainer, who has never held a scalpel in his life. No doctor should be forced to train residents, but isn’t that the case anyway?
Concerning this passage about doctors:
Does anybody know whether this idea is discussed anywhere else? Not being a medical expert myself I am sceptical that this idea is applicable to the full extent that seems to be implied here. It would only work if good feedback loops are established between the professions, so that information can backpropagate when the surgeon discovers that the wrong treatment was chosen and that was due to a wrong diagnosis which was made because the examiner overlooked some symptom. This point made by Petja Ylitalo above seems to be related:
I do not know what exactly an Outcome Evaluator’s job would be (in most cases patients should be able to evaluate the outcome themselves just fine), but I imagine somebody collecting data on remissions or, depending on the severity of the illness, survival rates and making this information public combined with the most relevant patient characteristics. I think that would be a great way to help doctors improve their skills and to improve patients’ decision making, so I agree that makes sense.
There already is some specialization in medicine. Doctors are not supposed to be experts on everything and radiologists do diagnoses, but (mostly) no treatments. General practitioners often do preliminary diagnoses and send people off to specialists who then do their own diagnosis and treat the disease. In many cases this is all that is needed. The last time I went to see my general practitioner it was because I had clear symptoms of borreliosis. The doctor looked at me, said “Well that looks like borreliosis.”, did a blood test that confirmed this suspicion and prescribed what I understood to be the standard antibiotic against borreliosis. After a few weeks he did a second blood test to see whether the bacteria had gone (they had). I don’t see a need for specialized examiners, diagnosticians, treatment planners or outcome evaluators here, nor for the general practitioners’ profession in general, nor in the emergency room. Furthermore, in these cases splitting up seems unfeasible because the services of general practitioners need to be widely available and cannot fully be carried out online and in the ER time is of the essence, which prohibits the slow communication entailed by this model, although the idea probably makes sense for chronic diseases and cancer. I think orthopaedists often recommend and then perform surgery, which seems clearly bad. It needs to be discussed to what extent encouraging patients to seek second opinions would already help alleviate the problem without reorganizing the whole medical sector.
I think training on the job in general is very useful (I wish I would have got trained on the job instead of studying at uni) and in all fields I would like to see more practitioners becoming teachers. That does not mean that teaching and performing are perfectly correlated and we cannot have some differentiation between teachers and practitioners. Just like not all drivers are driving teachers, but all driving teachers are drivers, all doctor trainers should be or have been practising doctors. I assume/hope that surgical residents perform their first operations under the supervision of somebody who not only knows how to perform the procedure and can advise them, but also can intervene themselves if need be, i.e. under the supervision of a surgeon and not just some sort of surgeon trainer, who has never held a scalpel in his life. No doctor should be forced to train residents, but isn’t that the case anyway?