Training New Doctors for the System

April 15, 2015

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Medical schools are creating a new type of doctor. National Public Radio recently discussed medical training in the 21st century:
“Spurred by the need to train a different type of doctor, some top medical schools around the U.S. are tearing up the textbooks and starting from scratch.”
The new doctor is system-focused. “One big shift at many schools is a focus on how the entire health system works – rather than just training doctors how to treat patients,” reports NPR. But students pay for medical school (in dollars and time) to learn how to diagnose, treat, cure and care for patients.
The new doctor is team-focused. A University of Michigan Medical School instructor told NPR, “ We haven’t taught people how to be specific about working in teams, how to communicate with peers and colleagues and how to communicate to the general public about what’s going on in health care and medicine.”
But that’s not what medical school is for. Doctors should be advocates of patients, not spokesmen for a system that is rapidly losing its patient-focus.
Furthermore, doctors have always been part of a team – they’ve led the team – but this new “team-based” group-think sidelines physicians and puts a collusive system of government and health plan interlopers in charge of patient care. Non-physician team members will be empowered to follow computerized treatment protocols approved by some corporate-approved “lead physician” far from the patient’s side.
Recently a gentleman concerned about his friend wrote me the following:
I asked for a meeting with someone at the hospital system to learn how care is delivered. This was prompted by an experience with my neighbor, an older woman with no local relatives who relies on us for such things. 
I was frustrated with her care, because I could not identify who was in charge of decisions regarding her care.
The hospital appeared to be on auto-pilot, with each nurse and/or doctor deferring to others and denying having made decisions. My question for the head of health policy at the hospital was how the hospital has come to operate in a way that seems explicitly designed to ensure that NO ONE is fully responsible for the care being given to a given patient.
It seemed to upset her when I suggested that the approach to care was that of a team without a lead. She was very insistent that there is someone in charge, but was unwilling to ID that function/person. 
My conclusion was that hospitals these days are "data driven", based on the constant deference to the computer in the room, and the fact that when I asked what decisions were made, and who made them, I **never** got a satisfactory answer.
Medical decisions are increasingly made by the system. How soon before smart, skilled, critical thinking students dismiss medicine as a career option? Why spend 11 to 15 years in college, medical education, internship, residency, and specialty training only to be told by unskilled outsiders how to treat patients?
Will this mean fewer doctors and more computerized treatment protocols for patients?
No physician is perfect, and every doctor should be open to ideas from their patients and other caregivers, but if you can’t find a physician directly accountable for your medical care, you’re likely being treated by “the system.”  If so, let us know.
Working with you to protect patients from system-based care,
Twila Brase, RN, PHN
President and Co-founder