Over the ages, medicine has drawn to its ranks the best and the brightest, attracted by a career that brings together scientific knowledge, rigorously developed skills, and good judgment to help those in need. Whether it’s breaking an asthma attack, delivering beautiful babies (even eight at a time), transplanting a heart, or comforting a dying patient, serving the sick—each of them a unique person—fills the minds of prospective doctors more than the daily onslaught of stories describing a medical system in crisis.
How could it be that the physician who touches the patient and sees how medical marvels create healthier lives seems so at odds with the public perception that the medical system is broken? The answer is that both are right. Grand success in patient care has increased the economic burden on society, which in turn has brought medicine’s benefits under scrutiny. As we look ahead, physician decision-making and the biomedical research that makes medical care better will be reconciled with cost-effectiveness. And three innovations based on information technology—clinical practice guidelines, electronic medical records, and large-scale population science—will bring medicine into a new biological revolution.
Population science—or epidemiology and biostatistics—studies health and diseases in groups, not indiv-iduals. Once the domain of public-health officials tracking outbreaks in faraway places, epidemiology can now evaluate the frequency, morbidity, and mortality of virtually all health conditions and can assess the quality of the health system itself. The doctor who touches the individual sees success when an obese patient responds to a new bariatric intervention. But from the population perspective, obesity is a growing epidemic, fueling diabetes and heart disease and aided by social determinants like fast food. In this view, obesity is a failure of American medicine.
This disconnect between public health and personal health is changing as epidemiology and biostatistics offer a kind of macroscope that complements the microscope and stethoscope in assessing environmental and biological factors that underlie individual diseases. And epidemiological principles guiding controlled clinical studies have become the gold standard for evaluating medical interventions.
Evidence-based guidelines are a boon to practicing physicians and promote more uniform and higher quality care. At the same time, those who touch the patient directly must use them wisely: as guidelines, not as dictates that supplant critical thinking or oversimplify more complex and mysterious illnesses. Many a doctor has been humbled by charting therapy based on statistics that lead him or her to say, mistakenly, “This man has three months to live,” or “This child will never walk.”
On the record. Another innovation that will benefit patient care is the integrated electronic medical record, which will make information more available, more accessible, and more accurate. A powerful side benefit will accrue to population research itself because computerized information on virtually every American can be compiled, searched, shared, and analyzed. The government assures the public of medical privacy, but it will be the responsibility of the physician to see this is honored, for it is physicians, not the government, who have taken an oath to protect the secrets of their patients.
The national medical record will surely improve continuity and weed out redundancy of care. Integrating electronic medical records with reimbursement data will make immediately transparent the economic implications of the doctor’s pen. This information should help physicians rein in inappropriate costs. It will also make it imperative for them to weigh in when arbitrary reimbursements inappropriately deny their patients care.
Information technology is ushering in sweeping changes that should make medicine better and safer. It will be the obligation of the physician to make sure that it remains high touch as well as high tech. That can only enhance the joy of being—and wanting to be—a doctor.