Tuesday, November 23, 2010

Enabling Error: Med students, mistakes, and modernization

Why does health care seem to lag behind other industries in innovation? There's a temptation to manufacture reasons that don't necessarily explain why health care has not seen the kinds of revolutionary changes evident in industries from computing and telecommunications to music and retail? People routinely marvel at how easy it is to manage their bank account these days, but they don't appreciate continuing to wait hours in their doctors' offices, repeatedly filling out patient information forms, and fighting to get a satisfactory amount of quality time with their doctor.

The knee-jerk temptation is to hurl blame at doctors' conservative outlook, the industrial medical complex, or just frank stupidity. I think these judgments are misguided.

Isn't it more plausible that a field as deep and rich as medicine, mediated by society's most talented and committed proferssionals, may have other reasons for slow adoption of change? Might there not be genuine, inherent features of medicine that fundamentally alter the patterns of modernization? Isn't it obvious that the currents of innovation in manipulating computers or music may be different than the interventions with living, feeling humans?

I am certainly in favor of modernizing health care, but I think we need to catch our collective breath as we rattle off our demands for innovation within this field. Can we address the inherent aspects of good medicine that inevitablly impede change? Will an accounting of these aspects improve the application of new technologies?

A more charitable culprit for medicine's resistance to change: the inacceptability of mistakes.

In his book What Technology Wants, Kevin Kelly describes innovative systems as those that enable mistakes. Yet, medicine selects the best and brightest largely to avoid the steep consequences of mistakes in health care. Consider the difference between unleashing an operating system continaing an unforeseen glitch and promoting a drug that contains an unforeseen side effect. I think it's clear that there is much greater tolerance for poorly performing computers then there is with poorly performing hearts. How then can we expect medicine to adapt and evolve with anything close to the rapidly of other industries?

Create a parallel system of patient care, run by medical students, that enables mistakes.

Imagine a system that tries out innovations without directly impinging on care? Generating such a system would be asking too much of practicing physicians' time, but not so for medical students. Everyday patient care wouldn't necessarily suffer if medical students tried their hands at using iPhone apps to diagnose, wireless tools to gather health data, and social media to network with each other about solutions. They could explore alternative treatment modalities and investigate methods of tracking current treatment outcomes, all the while interacting with real patients with real complaints and operating under the guidance of expert practicing physicians.

This project could drive innovation among seasoned doctors by testdriving potential innovations right in the clinical setting. Moreover, if a student innovation succeeds, the established doctors can morph this new opportunity for improved care in a streamlined fashion. Currently, if doctors want to adopt an innovation, they must change wholesale, which is much more disruptive to patient care and physician morale than streamlined morphing.

Freed from the understandable shackles of consequence, medical students hold a unique opportunity to spur innovation in an understandably resistant field.

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