Monday, April 2, 2012

Doctor Digitus: Recipe to Retake a Profession

Published in 1982, relevant in 2012.

In The Social Transformation of American Medicine, Pulitzer Prize winner Paul Starr outlines a medical history wherein doctors were exemplars of professional sovereignty: authoritative, powerful, "unambiguously important to their clients," nourishing their "thirst for reassurance."

Mastery of their profession was easy when doctors' heads were the sole repository of medical information, when medical error rates were not measured or published, and when a doctor's reputation was respected a priori, rather than questioned a Google. Patients had to come to them, in person. With no conceivable alternative, they had to bestow upon them their trust.

Unfortunately, that trust has eroded. Is there a way for physicians to retake their profession?

Simply put, professional mastery tracks with information mastery. In the 1980's, the two cohered: a doctor could master books and journals in a way patients couldn't dream, and control of the profession was unquestioned. Today, the digital explosion has left doctors playing catch-up, with patients arriving at the office with their own list of Web-derived diagnoses.

To retake the profession is to regain information mastery, which is to attain digital dominance: Doctor digitus.

In The Creative Destruction of Medicine, Eric Topol writes about Homo digitus, where the bright future of healthcare is a convergence of patients' digital and bodily selves. For Topol and others, the future of health is digital. Digital digital digital.*

What can Doctor digitorus do?

1- Outperform Google by giving patients the background information on their diagnosis, treatment, and prognosis from good, clear sources created by doctors and/or vetted by doctors.

2- Outperform alternative medicine by connecting with, communicating with, and supporting patients' need to feel empowered and in control of their health future.

3- Outperform scorecard medicine in magazines and online, where reputations hang on the caprices of frustration and marketing, by establishing a robust online presence that drowns out

4- Outperform distractions by creating engaging apps and other tools that encourage patients to maintain healthy behavior patterns, from diet and exercise to adhering to treatment regimens.

5- Outperform voter apathy and discontent by using modern media to promote the mission of medicine.

6- Outperform the past with quality improvement tools that measure and highlight avenues to decrease medical errors and avoid avoidable care.

7- Outperform the pace of knowledge-creation with tools that curate valid medical breakthroughs that matter clinically.

8- Outperform traditional medical education by teaching with digital tools.

Every one of these steps involves mastery of digital tools. Which have I left out?

*Don't take it from me, check out some of my favorites


Paul Sonnier said...


Amazing post!

Might I suggest adding Dr. Eric Topol to your favorites? Well, he's one of my favorites, anyway... and how I came across your post. :-)

I hope all is well.

Best regards,
Paul Sonnier

Founder, 9,900+ member Digital Health group on LinkedIn
Head of Digital Health Strategy, Popper & Company
Mentor, Blueprint Health
Co-chair, Healthcare Communications SIG at CommNexus San Diego
Twitter: @Paul_Sonnier

astupple said...

Paul- thanks so much. Dr. Topol is surely one of my favorites- Creative Destruction inspired the entire post!

Jason Boies said...

Terrific post, Aaron.

Truly a manifesto for any medical pro looking to dive into social media/digital.

I'd add Dr. Howard Luks to that list as well. He's got a great grasp on digital for healthcare to be sure.


Jason Boies
Radian6 Community

kate said...

Thanks for the article! You have given me some wonderful links and tools that will serve me well in Honduras. Digital tools allow my "wilderness" practice to run much more efficiently; sounds like a contradiction but with the right hardware and software - awesome streamlined access to resources and well, you know the rest!
BTW, I have been trying to reach you via Twitter about some of the things you've written under wiki. If you'd email me so that I could email you - I would be grateful. Sorry, I know I am off-topic here. Kate Spelman

Heather Logghe said...

Hi Aaron,

Great post! I am wondering what you mean by #2?

2- Outperform alternative medicine by connecting with, communicating with, and supporting patients' need to feel empowered and in control of their health future.

Heather Logghe

astupple said...


There's a reason for the growing flood of patients seeking alternative medicine, and I'm persuaded that it's the need for a sense of empowerment.

Traditional doctor-patient relationships involve not only passive but submissive behavior from the patient. Submit your time, come to my office, remove your clothes, let me examine you, offer whatever explanation I can squeeze into a fifteen min visit, and then go back home and "take your meds, eat less fat, exercise more."

Americans like to take charge, and there's a thrill to being able to dismiss the heavy hand of traditional medicine and go find your own healer who has time to explain their plan and offer remedies with great promise.

It's a guess, but if patients could feel like they are more in charge of their allopathic (traditional) care, then they'd be less inclined to seek their own solutions with alternative providers.

Here, I'm suggesting that the way to engage patients is by digital media, so they can see what their doc is thinking, can ask questions and understand the plan for them, and have an avenue to make themselves heard (it's hard to assert yourself in a rushed 15 min visit, easier when you have the time to sit in front of a computer and offer your thoughts and feedback).

Disclaimer: I am not criticizing traditional medicine for not engaging patients better- engagement takes way more time than current reimbursement schemas allow. Most docs I've seen really, really try to educate and empower their patients. My hope is that we now have the tools to make this feasible.

Thanks so much for commenting!

Heather Logghe said...

Hi Aaron,

Thanks for your response. I completely agree with you on the need for a medical model that empowers patients and fosters respect for the essential role and responsibility they play in their healthcare.

I second your thoughts that social media offers an unprecedented opportunity to educate and engage patients outside of the confines of the doctor’s office or hospital setting. I am really impressed by the goals of Stanford’s Medicine X conference to integrate epatients into an academic conference that explores the intersection of technology and medicine. I am enthusiastic as epatients expand their voice and influence.

I think I differ from your viewpoint in that I feel that the appeal of alternative and complimentary medicine extends beyond patient empowerment. The holistic approach of integrative medicine can offer modes of healing not available within the realm of traditional medicine.

For example I tried numerous medications for chronic migraines without success, and ultimately found a cure through interactive imagery led by a family medicine doctor, Dr. David Rakel, who has been a pioneer or integrative medicine.

I have great respect for physicians who are able to think outside of the box when traditional Western medicine does not cure that which ills their patients. In the end it doesn't matter whether we understand the exact mechanism of healing. As a future physician, what matters most to me is that my patient feels better.


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