Impact

I had a really interesting conversation with my girlfriend yesterday evening.  We are both Junior Doctors and not too far from finishing our postgraduate degrees when we will both become GPs.

We both became doctors to help others, create a better world and help people achieve their full potential through health care – in other words we wanted to have a big impact in the world.

When you become a doctor in the UK there are a limited number of routes you can take – you can either become a medical doctor, surgical doctor, family doctor etc.  However, none of these routes seem to have a big “impact” any more.  When I come home after a shift I rarely feel that I have made a real difference in another persons life.  Perhaps at most I may have played a small role in saving a life, but the feeling of having an impact soon disappears when the realisation that my role is easily replaceable in most life saving scenarios hits me.  So much of medicine now is following guidelines and literally doing your ABC’s (airways, breathing, circulation….) that medicine feels like it has become like a factory job and the patients feel like objects on the assembly line.  As a factory worker I am easily replaceable (by other doctors, resuscitation officers, nurse practitioners etc.) in many clinical settings.

Atul Gawande once wrote how in the 1930’s when a patient was admitted to a hospital there would pretty much be about two people looking after you.  That would be the doctor and the nurse.  In the modern day, this number has sky rocketed to about 70 people.  This includes a group of doctors from all different specialties, a group of nurses, pharmacists, porters, phlebotomists, radiologists, lab technicians, radiographers and so on.  This combined with the fact that medicine has become more of a tick-box job and following protocols and guidelines has meant that that feeling of having an impact as a doctor is at an all time low.

Naturally we asked each other; “well, how can we have an impact then?”.  I thought it was interesting that we both thought that having a medical education and some medical skills could actually still have a big impact in places with very little access to health care.  So, in places like rural India or parts of Africa, having more skilled professionals will make a massive difference to health outcomes and that must be a very fulfilling experience for clinicians who work in those parts of the world.  But, really neither of us thought that you could really make a big difference with traditional medical skills and knowledge in developed countries like the UK any longer.

It really seems that the future of healthcare will be through technology rather than practicing medicine in the more traditional sense.  There is no doubt that some technologies are already catching up to and surpassing what a human being is capable of.  For example doctors like Jack Kriendler are already on the cutting edge of what is capable with technology and have the vision to see what the future holds.  In his recent WIRED talk he spoke about how human instinct by doctors is often not questioned and is not evidence based.  Or, how software is already 15% better than the best radiologist at detecting whether something is a lung tumour or not on a chest x-ray.

Jack Kreindler speaking at WIRED Health 2015

Is it any wonder why Apple is investing millions into healthcare?  The need by people for on-demand healthcare with the best evidence available will only be achieved by using technology.

So really one has to ask whether continuing with the traditional medical pathway is in any way going to help me or my girlfriend reach our goals of having a fulfilling career.  It is likely that we will follow “non-traditional” pathways after our postgraduate training is over (such as combining medicine with research and travel or medical entrepreneurship)  rather than continuing.  This would allow us to live a more fulfilling life and will likely allow us to have a much bigger positive impact in the world.