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Tuesday, October 27, 2009

Disruption - Who moved my cheese moments in history

I can't say I know exactly what is coming that will disrupt the world of medicine. After listening to the Christensen video and reading his book "The Innovator's Prescription", it is clear to me that economics, social and technical change will result in major changes in the not to distant future. As in the words of one of my colleagues you cannot have change if everything remains the same. The question is, what will actually change? What should change?

I won't begin to answer those questions since I am virtually guaranteed to be wrong. What I can predict without question is there will be winners and losers. I suspect that physicians will be perceived as being relative losers but the reality is more nuanced that this. Some physicians have already been relative losers in how the health care drama has unfolded. The fate of the reminder may turn out to similar. However, it is unlikely that docs will be driving cabs as suggested a number of years ago when sages predicted a glut of physicians.

Whatever the outcome, disappointment will likely be out of proportion to actual fate. There is nothing like rising expectations and feelings of entitlement which are subsequently dashed to serve as the genesis of major disappointment. This may serve as the source of personal disappointment or even population wide resentments. I recall reading a book "Balkan Ghosts" by Robert Kaplan a number of years ago. In this book he detailed the history of the Balkans. The book came out in the early 1990's immediately after the death of Marshall Tito and the fragmentation of Yugoslavia.

I was struck by the resentments described and their historical origins. It turns out that essentially every ethnic group within the confines of the former Yugoslavia had overseen a large empire at some point in the past and the geographic extent of each of those empires overlap extensively. All the groups believe that the largest area occupied by their respective historical empires represent their entitlement and they will have no peace until they can restore their specific empires to rightful places. Such expectations are the perfect set up for disappointment and conflict.

We have lived through what can be viewed as a golden age of physicians. The diagnostic and therapeutic powers we have acquired along with the remarkable earnings have been without parallel in modern history. Our empire is perhaps at its zenith. It is only a matter of time before our power and influence will wane and our earnings power will moderate. The reality that ours is a service activity and that we will become more and more beholden to our patients is not an altogether objectionable end point. However, it will mark a change from the PAX Doctorus empire. We and our patients will be best served by resisting the temptation to strive to restore the old order.

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