saving doctors from themselves: designing medicine with ... · designing medicine with empathy and...
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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
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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”