When Doctors Quit

June 1, 2015
Intrigued by The Washington Post Opinion piece entitled, “Why doctors quit,” by Charles Krauthammer, I began asking what this means for Health and Healthcare Informatics. I realized that we need more clarity about what physicians actually do, if we are going to consider the implications regarding When they quit.

As I was thinking about this blog, a friend sent an opinion piece to me from The Washington Post entitled, “Why doctors quit,” by Charles Krauthammer. It was well written, succinct, and accurate. Like any writing, including this blog, it was necessarily incomplete. What intrigued me most was this sentence from the column:

“You may have zero sympathy for doctors, but think about the extraordinary loss to society — and maybe to you, one day — of driving away 40 years of irreplaceable clinical experience.”

It was the “irreplaceable clinical experience” that I found sufficiently incomplete as to warrant this post. The gist of it is that when you need a competent doctor, you cannot backfill that need with Google search, IBM Watson, a professional association’s clinical practice guideline, or the potentially relevant information sources that might have a greater economic interest in presenting the information we’re seeking in a biased way.  Clinical experience is a unique juggling act between genuine empathy, diagnosis, treatment, and communication. “Why doctors quit” alludes to this, albeit from a certain partisan posture. My concern is more focused on “When doctors quit” in terms of juggling that act, and specifically what irreplaceable value we’re talking about.

As quick background, I am huge fan of consumer convenience, so I am big fan of the advances being made by retail chains with telemedicine. There’s a great example and brief video discussion of these advances with Walgreen’s CMO, Harry Leider, M.D. here. No one viewing this thinks it is a complete substitute for a face-to-face, in-person interaction with a doctor when there are important benefits versus risks to arriving at the right decisions on diagnosis, treatment, or both.

What I want to share here is that there are four approaches people, including doctors, use to make decisions regarding what to do. These decisions are progressively sophisticated from 1) simple rules, 2) cumulative inference, 3) serial logic, and 4) parallel weighing of the resulting, often complex alternatives. Physician’s with irreplaceable clinical experience use all four approaches. It’s impossible to fully automate or otherwise replace the fourth approach, and silly to try. 

I think Krauthammer’s point is that for political and economic reasons, we are throwing the baby out with the bath water. And my point is that to make the right policy and economic decisions, we must recognize and value this very real, four-level consultative ability. Maybe the right word is simply “judgment.” That is what we risk losing when physicians quit.

What do you think?

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