Message to doctors: What we can all heed from Bob Dylan when responding to changes in health care

December 9, 2021 | Author: Dr. Richard Reznick
4 MIN READ

In this article:

  • Why we must learn to welcome change
  • How the digital revolution will continue to shape health care practice and patient interactions, and even new career pathways post-medical school
  • A challenge to embrace opportunities to influence and spur positive change

For the times they are a-changin’

This is a message to anyone who is younger than me…and that means students, residents, recent graduates, not so recent graduates and even those among you thinking of retirement!

Let’s not be afraid to embrace change. Indeed, let’s be restless for it. Of course, we have all seen many changes that have occurred in our health care environment so change is not anything new. But I would argue that the pace of change in the near future is going to rapidly accelerate and our natural aversion to change (cognitive dissonance, in psychological terms) may serve as an impediment to progress unless we adopt a personal mandate to challenge ourselves to welcome change and improve the health system.

A revolution of change

In his recent book Sapiens, Yuval Noah Harari speaks to the three major revolutions of mankind: the cognitive revolution, the agricultural revolution and the scientific revolution. I would posit that we (and especially those of you in the early stages of your career) are now living through mankind’s fourth major revolution: the digital revolution.

And how lucky are we for that!

Technology will certainly have a profound effect on medicine. Future interactions with our patients won’t, in many ways, at all resemble the interactions that those of my generation are used to. Instead of waiting rooms, faxes and an appointment in three months, we will — and are already seeing this happen, given lessons from the pandemic — transition to more electronic consults, virtual visits with patients, electronic prescribing and text messaging for rapid fire communication.

The digital revolution will even challenge the essential nature of specialty medicine. My own specialty was colorectal surgery. There is absolutely no way that, in 50 years, future surgeons will operate on colons the way that I did. Artificial intelligence (AI) will predominate in diagnostics and smart robots will do surgery in more precise ways than we could have ever dreamed. And I’m confident that the same will be true for all, if not most, specialties.

In our recent Royal College Task Force on AI and Emerging Digital Technologies, we quoted medical futurist Bertalan Mesko, who said that AI may be the great democratizer of health care. Given the prospective impact of natural language capabilities of future machines, and their ubiquitous use in an AI-enabled health care environment, the very nature of the patient-doctor interaction may fundamentally change.

It is up to us to be adaptable, innovative, creative and not afraid to accept change.

Let me tell you an interesting story

While I was on sabbatical a few years ago, I had a very interesting conversation that made it clear to me just how profoundly the digital revolution is going to shape the careers of our youngest colleagues.

I was visiting an organization in London, England, that is owned by Google. Called DeepMind, its health division explores the interface of AI and health care. While I was talking to some of the many people who work there, I met a young woman who had recently graduated from Stanford University School of Medicine. To me, this was a little strange. What was someone who had just graduated from a prestigious medical school doing working in the tech industry and not pursuing residency? But she made it clear to me that going to work for DeepMind was her first choice after graduating. She said that it had been her goal to work for a company that focused on developing AI for health care. Even more surprising, she said that many of her classmates at Stanford had similar goals. By her estimate, 1/3 of her graduating class planned to pursue non-traditional medical careers, many in health care technology.

In my generation, there was only one reason to go to medical school: to become a practising physician. Things aren’t that straightforward now. Maybe that’s a little scary but it’s also incredibly exciting. Because, with innovation and even iconoclastic approaches to today’s health care challenges, we could be at the cusp of an amazing future.

Nurture that same spirit that led you to medicine

I remember, as a recent dean, telling our medical students “you are going to have to be open-minded and flexible as you go through your careers. You’ll need to take up the technological revolution — grasp it, capture it and get it working for you. Under your control, new technologies will change the way we deliver health care. But I’m confident it’ll be for the better. And to do that you are going to have to foster and intensify your creative and innovative spirit. The same spirit that got you into medical school. Please don’t lose it.”

For many of us, a long way from our days in medical school, I believe the message is still the same.

We know our Canadian health care system needs adjustment. Many of the issues we are now facing preceded the pandemic. If anything, the last two years has just brought them in to sharper focus. As we look ahead, we need to embrace significant change to rebuild a stronger and more resilient health workforce and care system.

Some of us have leadership roles — this provides an opportunity to influence evidence-based, system-level improvements.

Some of us have teaching roles — let’s inspire our trainees to be even better doctors than we have ever seen or imagined.

Some of us may be involved in advocacy — our voices can be effective in promoting fairness, equity and a judicious use of our resources, especially when those voices embrace change.

No matter what specialty or in which setting you practice, we could all benefit from being a little bit restless for change because, at its heart, that is where creativity, innovation and improvement stem from.

I’m not sure Dylan was talking about artificial intelligence or health care system change when he wrote the stanza below but he could have been delivering us an important message:

May your hands always be busy

May your feet always be swift

May you have a strong foundation

When the winds of changes shift

May your heart always be joyful

May your song always be sung

And may you stay

Forever young  

How has change impacted your practice experience? I would welcome the opportunity to read your reflections in the comments.

Richard K. Reznick, MD, MEd, FRCSC, FACS, is the 46th President of the Royal College of Physicians and Surgeons of Canada. He is the founding director of the Wilson Centre and previously served as chair of the Department of Surgery at University of Toronto and dean of the Faculty of Health Sciences at Queen’s University.


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Ken Foster | January 3, 2022
This response may be a little tardy but is triggered by an essay in the NEJM about the way that Amazon is moving into health care. It is taking advantage of the internet and associated technologies and economies of scale to skim off the cream of low hanging fruit in health care delivery targeting the simple low risk interactions which ends up selecting for low risk efficient health care encounters with preferentially younger and more educated patients leaving the complex difficult expensive care for the public system. Thus AI becomes another tool to widen the gap between the haves and the have-nots, notwithstanding the real benefit that it can provide for those for whom it works.
Dr. Richard Reznick | January 5, 2022
Ken, thank you very much for bringing this to the attention of our readers. When we ran the task force on artificial intelligence, we heard that it could be a great democratizer of healthcare. But you bring up a very salient point, that if we are not careful, it could work in the opposite way. The entire arena of social justice with respect to the deployment of AI, is a very important area of study, and I would suspect a very nascent field. Thanks again for bringing this to our attention. Richard Reznick
Heidil Martins | December 11, 2021
These doctors who are not practicing clinical medicine now are a problem for me and my husband. We do not have GP like 30% of the citizens of Victoria after I have been working in oncology for 33 years. Now when our health problems are complex and we need proper consistent care we are left to phone Telus health and are discouraged to attend the ER, and cannot get appointments with walk in clinics.
Dr. Richard Reznick | December 13, 2021
Thank you Heidil, Your point is a good one and I personally believe that it is true that we are "under-doctored" in Canada. Especially when one looks at the maldistribution of the work force. That said, I do believe we need a subset of future physicians who are going to focus on technology's and will need to take that into account with respect to person-power planning. Richard Reznick
Marie-France Rivard | December 10, 2021
I enjoyed your comments. As a retired psychiatrist, I look forward to seeing the younger generation of physicians embracing technology in a positive way but also maintaining human contacts and collegiality with colleagues that is crucial to providing quality health care.
Dr. Richard Reznick | December 13, 2021
You said it better than I did! That balance between modern-technology-based care, and patient-centred humanistic care, will be critical. Richard Reznick
Mark Farrell | December 10, 2021
Excellent article. You had me at Bob Dylan !
Dr. Richard Reznick | December 10, 2021
Thanks so much Mark, it looks like we’re both Bob Dylan fans! Appreciate the comment. Richard
Myra Sourkes | December 9, 2021
Hi Richard I appreciate your comments and agree with them. In terms of your comment that “the very nature of the patient-doctor interaction may fundamentally change,” I think it already has. While that is mostly a good thing, I am concerned that it has resulted in some loss of clinical intuition – some diagnoses are best made when the doctor spends a little longer with a patient than they really have time for, asks probing questions, listens well and thinks outside the box, or simply provides the human touch. I am concerned that that is not valued or emphasized enough these days. I am not sure that an AI algorithm is able to replicate that, although maybe one day……
Dr. Richard Reznick | December 10, 2021
Myra, how nice to hear from an old friend. I agree with you entirely. Around the table at the AI task force, we often said that AI will not replace doctors, but doctors who do not embrace AI might be replaced. To your point, we will never get to a situation where caring, compassionate care is given by anyone or anything else than a well trained clinician.
Philip Andrew | December 9, 2021
The current EMR is in chaos and it's more of an impediment than a benefit to optimum medical care. I am the Mike Holmes of the EMR. In its current iterations the EMR is rotten to the core and the whole thing needs to be torn down and rebuilt from scratch to MAKE IT RIGHT! It’s already in collapse under its own weight. At least in this province (Ontario) chaos was essentially a certainty insofar as our previous Premier threw $8 billion into its creation evidently based purely on the premise, "I have no idea how to create an EMR, but if I throw enough money at it, how can it go wrong?" What did Diane Francis tell us in the Financial Post May 28, 2021 … “Our country is run by amateurs who hire more amateurs, the consultant gravy train is well-established in Ottawa. What’s new is the unprecedented scale.” As but a small example, OLIS in Ontario blatantly touts the medical information benefits it has been MANDATED to fulfill, but the shysters they are saw fit to toss the whole thing over the wall to the EMR interests. Having presumably been financially persuaded that they actually knew what they were doing by their share of the $8 billion, my EMR, widely touted as “the best” to this day, in my practice and all others, delivers “medical information” as a series of daily “jigsaw puzzles” dumped onto my lap and declaring, “there’s your medical information, doctor, have a nice day!” Not unlike a farmer delivering the paid customer milk … that’s still in the cow. I have a schematic of what needs to be accomplished and I'm eager to share it with our government at the highest level ... I learned recently that one of our current Prime Minister’s lifetime ambitions has been to make a notable difference in the world of healthcare that would endure long past his term on office. Canada, with its Turing prize winner, etc., etc. has the brainpower to do it RIGHT. I can show the Prime Minister, and the other true geniuses and professionals (absolutely no sarcasm here) at his side (Deputy Prime Minister Freeland, our Federal Minister of Health Duclos, possibly others) how Canada can Rule the Electronic Medical Record WORLD. Other Major Powers such as the US (where I have practiced), the UK and its NHS, and many others have been manifestly unable to get out of their own way on this enormously important task. Can you help me (implicitly us all)? Sincerely, Philip Andrew, MD, FRCPC (Int Med, Cardiology), FACC
Dr. Richard Reznick | December 13, 2021
Philip, you certainly make excellent points and I know that its true that our history, in Canada, regarding adopting technological solutions to medical records and other health information needs has been sub-optimal. That said, I do not have a great amount of knowledge in this specific area, but rather believe that we ultimately need to embrace new technologies. That said, we have to work to get it right, so that it actually improves health care, not impede it.
Douglas Courtemanche | December 9, 2021
Technology is just one side of the coin of life. Humanity is the other. We risk losing humanity if we overly embrace technology. Technology is expensive and is not going to scale down so that we can reach indigenous, rural, impoverished inner city and dependent populations - people who need medicine more than the 1%. Medicine is the practical application of knowledge and skill to the care of patients. Care is a human experience, something that happens between people - a relationship. At present I do not see AI as "practical", disruptive yes, but not practical. Just because it is interesting and makes the headlines doesn't mean it's ready for prime time. There needs to be a quantum leap in the end user experience from what we have now in BC with our EHR and FESR software. And, I know from personal experience that getting large numbers of physicians to embrace technology in a uniform way, as a system, is more than a small challenge.
Dr. Richard Reznick | December 10, 2021
Dr. Courtemanche,, I certainly agree with you about the need for compassionate patient centred care, that will not and cannot be delivered by AI. That said, I honestly do believe that technology will bring disruptive changes to our workplace, and almost all for the better. Because like true of good friends, we will keep what’s worth keeping, and with a breath of comfort, blow the rest away.
John Kostuik | December 9, 2021
Richard, how true. Something everyone in the health care field needs to be cognizant of.,in my experience at least. 80% of surgeons are very hesitant about change or adapt new technology without thought. We live in the most rapidly advancing times in history so adaptation is more important than ever . I hope your thoughts get out to a broader community . Best wishes
Dr. Richard Reznick | December 10, 2021
John, thanks for your kind words. You are a personal example of someone who has always embraced change, and to the great benefit of your patients and the community of medicine. I am confident, that the younger generation of surgeons, and indeed all physicians, will be more adaptive to the technological revolution then our generation has been.
Angela Enright | December 9, 2021
Love your essay Richard. I'm a child of the Dylan era! Angela Enright
Dr. Richard Reznick | December 10, 2021
Thank you Angela. You have inspired so many around Canada, so it warms my heart to hear that you are also a Dylan fan.
Vijay Moonje | December 9, 2021
Amazing and timely. I will forward this to my granddaughter who is in her second year of medical school
Dr. Richard Reznick | December 10, 2021
Thank you Vijay. I’m sure both you and I are very jealous of your granddaughter, as she begins a career in the greatest profession, had an unbelievably exciting time.
Alan Lee | December 9, 2021
Excellent article. Pairs well with a trio of articles about "Machine learning in health care" in the November 2021 issue of Canadian Medical Association Journal.
Dr. Richard Reznick | December 10, 2021
Yes Alan,, I did see that excellent series. I am pretty confident that although we have seen a lot of technological hype in the last 20 or 30 years, AI (and machine learning) are the real thing, and will very much change our workplace