The end of medicine as we know it

What do you think of when you hear the word medicine? Perhaps you think of the remedies we use when we are ill, like tablets or herbs. Or maybe you think of the broader definition, “the science or practice of the diagnosis, treatment, and prevention of disease” as Google words it. If so, you may be thinking of a science and practice that is becoming ever more disconnected from what it was supposed to do, helping humans feel well. 

At least that’s what I was taught was our mission as a medical student some 20 years ago. But practicing medicine as a sleep doctor for a decade made it painfully clear that the tools we had available not only weren’t curing anyone, but didn’t even begin to address the root cause of our patients’ problems. Whatever relief and comfort was to be had merely patched up deeper issues for a little while. 

Once seen, the fact that the vast majority of us physicians weren’t doing what we had dreamed of couldn’t be unseen. We had become cogs in a machine that was losing touch with how society changed in the last decades. As this realization grew, I felt a need to speak up and hopefully spark a debate that could lead our profession back on track. I decided to write an op-ed. Or rather, an op-med, an editorial published by Doximity, a large network for medical professionals. As I was penning down my thoughts two years ago, I felt like medicine was at a crossroads, but that there was still time for doctors to become the healers we wished to be. 

This is the submission to Doximity from July 20, 2022 that I hoped would be part of changing the trajectory of medicine. 

Why physicians need to lead the wellness revolution

As physicians, we were taught that the key to success lies in following the manual. We were instructed that if we studied much and worked hard, we could become who we desired to be, a well liked member of society, working for the benefit of all to make the world a better place. 

The only problem: that world is changing infinitely faster than medical education and the practice of medicine. 

The great imitator no longer is syphilis, not even tuberculosis. Night sweats, palpitations and shallow breathing are signs of a new type of imitator more prolific in its manifestations than any that came before – anxiety. A permanent lack of energy, feeling weak and inexplicably inactive are no longer best explored with blood tests, but meaningful conversation about mood and lifestyle. Pain no longer comes from the tendons and muscles as much as it comes from deeper within. 

Not only has the reality of medicine parted ways with what we were taught decades ago, but the tectonic plates of care delivery are now rapidly shifting. 

Whereas only a few years ago the thought of seeking care using a sleek, rectangular device carried in one’s pocket seemed like science fiction, it is becoming the norm for all but the most senior generations. 

But one thing hasn’t changed, when our fellow humans are not feeling well, they want to talk to a doctor. A physician is still, in 2020, seen as the authority on health and wellness. And we have a difficult decision ahead of us: Keep trying to insulate ourselves from the true problems facing the world in the 21st century or embracing them.

We can continue doing what we are doing now, looking at symptoms squarely as indicators of a well defined pathological process that we can diagnose and treat. Or we can start the process of redefining what a physician is and include mental and physical wellness as an inseparable aspect of our calling. 

If we keep doing what we have been doing for the past centuries, a doctor will become an ever more marginalized and commoditized member of a society that turns elsewhere when truly in need of  help. But if we are ready to embrace the inevitable changes that are facing us, being a doctor will again become what it once was, that indispensable person in our tribe who heals all ailments, no matter from where in the mind or body they arose.  

But to transition in this way, to transform our profession in a more profound way than any of our predecessors could have imagined, we need massive action and we need it now. 

We need to dedicate a sizable portion of medical school to studying the mind so that we can care for anyone who is hurting on the inside. We need to use technology in creative and innovative ways that will redefine healthcare as we know it. 

We need to be at the helm of a wellness revolution and become its heroes.

We owe this to ourselves, those who came before us, and those who are still dreaming of becoming us.   

On the very same day it was submitted, my editorial was rejected. In fact, it took only one hour and 37 minutes before an email from an anonymous editor:

Thank you for your submission. At this time, we have decided not to include it in Op-Med. We encourage you to continue submitting and we look forward to any future submissions.

Although it is unclear who made the decision and for what reasons, something has become increasingly obvious to me. A voluntary change in trajectory from the medical system itself is unlikely to happen. It is far too established, too vast and too entrenched for any appetite for radical transformation. Medicine will not become where we humans find relief from the vast majority of what we struggle with. 

But this doesn’t mean change won’t happen. As the traditional practice of medicine becomes less relevant to the brunt of what ails us, the medical system will be forced to change. Whether it implodes under the increasing costs of layer upon layer of administration coupled with a disillusioned workforce or gradually diminishes in size as we find other ways to feel well, one thing is clear: we are facing the end of medicine as we know it. 

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