Tuesday, October 4, 2011

Disruption in the Doctor's Office

In Clay Shirky's engaging book Here Comes Everybody, he describes how professionals can be blindsided by disruptive competitors. It got me thinking about medicine.

Traditionally, new technologies reached medicine in a top-down direction. The invention of MRI, for example, was first introduced to hospital administrators and department chairs as a potential new diagnostic tool. Once accepted, others further down in the medical hierarchy gained exposure. 

This technology wasn't disruptive because it didn't change the overall structure of the field. As before, patients still came to hospitals for sophisticated diagnostic work-ups, only now the hospital had a better, albeit more expensive, tool.

Many of today's medical technologies are disruptive, which is different.

Take, for example, the iPhone app Skin of Mine. Take a picture of a suspicious mole and get either automated analysis about its likelihood of melanoma, or an online consultation with a dermatologist. 

This invention is entirely unlike the MRI scenario. Instead of entering the field from the top down, it comes from the bottom up. Patients can walk into their doctor's office with this invention already in their pocket, asking questions about a diagnosis made by their free mobile app, all without the department chair or hospital administration even knowing of its existence. 

This changes the overall structure of the field: the patient has direct and cheap access to diagnostics, less need for an office visit, and more information in the patient's hands. 

A crucial question for medice is how to respond to disruptive changes that come from the bottom up? My guess is that most clinicians, understandably, will not take kindly to innovations that reorganize their workflow. The nightmare of adopting a new EMR is trivial compared to the challenge of restructuring how and where a doctor sees patients. Nonetheless, I'm guessing this change will be inevitable as patients clamber for the cheap convenience of such disruptive technologies.

Personally, I think medical schools hold the key to ushering this bottom-up transformation. They can serve as the field-testing ground for disruptive innovations, training the near-future doctors as well as offering exposure to their more entrenched clinicians, but in a structured way that blunts the stress of disruption.

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