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SavingDoctorsfromThemselves:DesigningMedicinewithEmpathyandCompassion

UTOPIAORDYSTOPIA?VISIONINGTHEFUTUREOFHEALTH

”InAustralia,“goingwalkabout”referstoariteofpassagethattheAboriginalpeopleundertake—atimeofsolitudespentsearchingfor“songlines”oftheirancestors—theideabeingtoimitatethepastandreturnwithrenewedenergytofacethefuture… That’swhysonglines matter;ourhistorymakesusmorethanwemakehistory.”~SharadPPaul,TheGeneticsofHealth(SimonandSchuster)

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"Studentsundergoaconversioninthethirdyearofmedicalschool- notpre-clinicaltoclinical,but pre-cynicaltocynical."~Abraham Verghese

Pattern-recognizers

Proceduralists

Personal-physicians

ALGORITHMS:MELANOMADIAGNOSISEDUCATION

“Thereareinfacttwothings,scienceandopinion;theformerbegetsknowledge,thelatterignorance”~Hippocrates

“…Thepublicwouldbeshockedifitknewtheamountofunnecessarysurgeryperformed”~ HawleyP,DirectoroftheAmericanCollegeofSurgeons(ACS),1953

“Weperformsurgerybecausewehavebeentrainedtodosoandbecause“wehavealwaysdoneitthisway” orwesimplydonotknowanybetter.InGermanpsychology,thisbehaviourisanalogoustoahistoricentitytermed“Funktionslust”~ Stahel PF. Blood,sweatandtears— becomingabettersurgeon.Shropshire,UK:TFMPublishing;2016.p.320

“Whenspecialistsarepaidthroughafee-for-systemschemeratherthanonacapitationbasis,surgeryratesincrease78%.Theimpactofprimarycarephysiciancompensationonsurgeryratesdependsonwhetherornotreferralrestrictionsarepresent”~Shafrin J.HealthEcon.2010May;19(5):562-80

SurgeryasTherapy:ACommonsenseApproach?

Ifwetreatedsurgerylikeapharmaceuticaldrug,theprocedurewouldberequiredtoundergoscrutinyoftestingitssafetyandfeasibilityinphase1and2trials.Subsequently,itsefficacywouldhavetobeproveninprospectiverandomizedcontrolledtrialspriortoapprovals.

Yet,theFDAorsimilarbodiesdo not regulatesurgicalprocedures.Regulationisrather“self-certification”viaprofessionalColleges.

Iflevel1evidencedisprovesabenefitforacertainsurgicalprocedure,anyineffectivepracticewouldbecalledintoquestionandabandonedimmediately.Thisisnotthecaseinthefieldofsurgery.

Perfectionists(“Imustdothisright,mistakesareintolerable”)Narcissists(“Iamthegreatest”)Compulsives(“Imustdothis,andIcan’tgiveuptillIfinish”)Denigratorsofvulnerability(“Peoplewhoneedhelparefailures.IfIneedhelp,Iamafailure”)Martyrs(“Icareformypatientsmorethanmyself,andmyneedsaresecondarytothoseItreat”)

Whendoctorsneedtreatment:ananthropologicalapproachtowhydoctorsmakebadpatientsAlex Wessely, Clare Gerada ,12Nov2013

“Letfoodbethymedicineandmedicinebethyfood”~Hippocrates

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“Wherethereisloveofhumanity,thereisalsolovefortheartofmedicine”~Hippocrates

MyRegisteredCharity– Baci Foundation– MobileEducationUnitatGlenTaylorSchoolinAuckland

MyRegisteredCharity– Baci Foundation– MobileEducationUnitatGlenTaylorSchoolinAuckland

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drsharadpaul.comOpeningoftheMobileEducationUnit– May2018– Baci Foundation drsharadpaul.com

ImageHeadlineTellmewhattheimageisreferringto.

drsharadpaul.comOpeningoftheEducationUnit– May2018– Baci Foundation drsharadpaul.com

Conservation

Sustainability

MyRegisteredCharity– Baci Foundation– MobileEducationUnitatGlenTaylorSchoolinAuckland

MySkinSurgeryClinicinAuckland,NewZealand

MyRegisteredCharity– Baci Foundation– MobileEducationUnitatGlenTaylorSchoolinAuckland

MySkinSurgeryClinicinAuckland,NewZealand

drsharadpaul.com

SympathyScience

Sustainability

“Justaslawdoesn’ttranslateinto

justice,medicineisn’thealthunlesseachofustakespersonal

responsibility”