Ernesto “Che” Guevara was a trained physician before becoming a freedom fighter. As a medical student he sought to change the world through the treatment of leprosy patients. By the time Ernesto was in medical school a protocol and treatment of this chronic disease was widely available. His specialty of medical research became one of treatment rather then curing patients.
My experience with doctors is that through their training or because of their personality many present themselves as authority figures. As patients we revere their opinion and sage advice adding to this image. At least this is historically the case.
What is a doctor to do when their advice and knowledge is challenged? When Ernesto couldn’t fulfill his desire to make world-wide impact as a doctor, Ernesto became Che the revolutionary leader and freedom fighter. I have seen some doctors turn their attention to Health IT as a way to make significant changes in healthcare.
People with a calling for social change, especially through medical treatment have specific personalities. Doctors, Nurses and other care providers tend to be “sensing, intuitive and judgemental” personalities based on Myers-Briggs. These are generalized views yet, there is evidence that through training these are the personalities that are successful in the medical profession. People who seek careers in accounting or computer science tend to be much more “introverted, thinking and detailed” types. While medical science does tend to require similar discipline and logical thinking it seems to be much more intuitive than some of the more exacting disciplines that use much more quantitative evidence rather the qualitative techniques. How often have you seen a doctor have “gut reaction” to symptoms reported rather then get out precise measurements to make a diagnoses. Yes, we have much more measured scientific results through lab tests, decision support and evidence based medicine, yet in most cases the doctor just “knows” or at least gives this impression to the patient. If they have doubt it would affect many of their egos to show it.
Based on the differences in personalities it is a struggle to combine the Medical and Computer disciplines in a single individual to work on electronic healthcare. Doctors don’t want to be pigeon holed and required to document each atom of data. They want to stay in touch with the patient and see the computer as coming between them and their client. Electronic systems need to be used to be effective, data needs to be categorized and atomize so that it is easy to index and query. This dichotomy makes these two professionals difficult to combine their skills to create the best of both.
The doctor’s most successful tool is information. Years of training and exposure to medical techniques gives them the confidence to treat patients. In my experience they use few references and not in front of the patient. Many doctors’ rarely say, “I don’t know” or “let me look that up”. Partly this is training but also there is, I believe a desire to show no weakness to the patient, thus not losing their confidence. After all if you, as the client, have any doubt you may question other things that you are being told.
With the ever increasing availability of information we face greater challenges to medical information. Like the priest of old that kept scrolls away from the eyes of the worshipers became demystified once the Guttenberg press allowed laymen to see and read the bible themselves, today the internet gives patient access to medical information previously only seen my the “high priests” of medicine.
Patients at times know as much and sometimes more then their family doctor regarding their specific ailment. In the case of individuals with chronic diseases, who have had the conditions for all their lives, new doctors may be challenged by the patient who has had more and greater first hand experiences with the ailment than they do. All this challenges the medical profession.
Technology is seen as a threat to both nurses and doctors because the balance of power is shifting. Current privacy legislation even points out that all the personal and medical details gathered by doctors and nurses belong to the patient. The introduction of personal health information systems controlled and owned by the patient then further erode the hold of medical professionals on medical issues.