We who practice medicine are taught risk aversion, Above all, do no harm.
A recent article on Elon Musk by Christopher Cox in The NY Times Magazine of January 17, 2023, “Elon Musk’s Collision Course” makes a powerful argument for the exact opposite, a sort of “Damn the Torpedoes, Full speed Ahead,” approach that makes sense for the entrepreneur/inventor. These are two extremes.
What drove me batty, nearly to the point of quitting, after practicing clinical neurology for decades, is the computerized medical record with it, the command of managers to practice thoughtlessly on auto-pilot. I am not alone. Your non-medicinal managers are happiest with bland compliance, reducing physicians to data entry clerks. First of all I had practiced as the president of my own practice, no managers to tell me what to do. Loss of autonomy is the root of so-called, “burn-out,” inappropriately named.
But neurology is thought in spades which is why I love it. I went into it for the thrill of figuring things out. You have in your clinician’s head neuro anatomy and all forms of basic science, a wiring diagram of nervous system and the human condition. You and only you are the skilled expert doing that careful exam, dealing in rarified thought, solving puzzles for the health of the patient. But then today’s neurology clinic says to the neurologist, “Surrender your frontal lobes, all who enter!”
We are reaching the point of having excellent tests and scans and written protocols beautiful to behold. Many colleagues are fine with simply inputting data, foregoing the physical exam altogether, having no judgements or their own conclusions in their notes, just looking for what pops out. Although this work is what I would personally call unsatisfying, they appear ok with it.
I’d say only in some cases the lack of thought, the inability to take the wheel while driving, does cause morbidity and mortality for the patient at risk. In other words it’s exactly a Tesla auto pilot car driving off course which happens rarely. This causes me to wonder whether sooner or later, you may not need, the likes of me, a human expert system in the clinic anymore.
Which is more dangerous? Practice with thought, figure stuff out, use your best judgement. Depending on your skill that can definitely get the patient into trouble.
OR
Auto-Pilot medicine: Use the Algorithm.
At the moment, my take is, expert human supervision still is required.
To Invent and make Billions the entrepreneur has mostly to take risks.
Practicing medicine is the opposite, risk aversion.
Different styles of thought.
