Caring vs. Doing

We are at a branch point for change in medicine. While the big lights are focused on the halls of Congress, I am not sure that is where the drivers of the big changes will be. The fundamental changes which is is evolving in medicine can be summarized by asking one question. What will be the primary mission of physicians vs. other health care workers? Will the primary mission of most physicians be to take care of patients or will their mission primarily be to do specific things to patients?

During my practice lifetime I have seen a dramatic movement toward the latter. In retrospect, this is not surprising since the payment system for physicians rewarded us for doing things to patients. Add to this the movement toward specialty medicine where we are increasingly rewarded for becoming more focused and less capable for the general caring role.

Nature abhors a vacuum and the vacuum relating to caring for patients are being filled by non-physicians. There may be some limited resistance from organized medicine but most of these caring activities represent lower margin business. I can't help but relate back to Clayton Christenen's observations that disruptive new entires generally move into lower margin activities and quickly end up displacing those who previously occupied such niches.

The future appears clear to me. In the not to distant future, physicians will relegate their roles as caring for patients. Assuming this happens, the question I raise how will this change how we educate physicians. For professionals increasingly deployed to do very specific and focused tasks, what is the utility of lengthy, expensive, and broad training which is promptly forgotten?