Physician education today focuses on the “human” side of medicine: kindness, generosity and ethical behavior. When patients are asked what they like most about their doctors, they often mention that “he or she listens to me,” “answers my questions” or “is kind.”
At a recent “white coat” ceremony, where new medical students receive their first white coats as a symbol of entry into the profession, each presenter spoke of infusing their training journey with humanism and of emphasizing the kindness and service the profession requires.
Even the medical insurance plans today emphasize friendly, easy access for patients, while advertisements for hospital chains show teams of smiling doctors and nurses at your service. What’s not to like?
The missing ingredient here is one of the building blocks of world-class medical care: creativity. Creativity is what differentiates standard care from superlative care. It’s taking what is known — what is presented by each patient — and combining or inventing the best ways to solve their problems.
Why? Because much of what we think we know is not true.
Most of the information I learned in medical school is now outdated. Most of what’s “tried and true” is not really all that good. In the demand for “evidenced-based medicine” and standard-of-care protocols, people forget that the evidence is often not that well-founded, and the standards are sometimes made by economic rather than quality metrics.
For the most common surgical procedures in orthopaedics, for example — which include total knee replacement, ACL reconstruction and rotator cuff repair and meniscectomy — the failure rate varies from 15 to 30 percent. If the best our profession can do is succeeding three out of four times, we must acknowledge that the “state of the art” in orthopaedic practice is still in the formative stages.
Instead, four years of medical school are crammed with massive doses of information requiring rote memory. On top of that, students must learn the evaluation skills of the physical and mental exam. The clinical rotations endured by medical students are often structured with punishingly long hours — time often spent performing menial tasks at the beck and call of more senior residents. Residents-in-training are commonly used by attending physicians as servants to treat the poor in the middle of the night or as clones to absorb what the attending wants to teach. Many attending physicians, of course, are inspiring teachers and role models, and the best residencies produce well-trained, wonderful doctors. But can they innovate?
After five to eight years of training, most residents then spend another year or two in fellowship training programs. This is an opportunity to be mentored by someone with exceptional skills. Clearly, the residency didn’t prepare them to function in the real world, and this final stage is required to learn the art of medicine and surgery. Most residents do it — must do it — to get a good job and to really learn a specialty. And most such fellowships follow the model of cloning the professor.
If we want kind and creative doctors, is this the way to get them? The system doesn’t change, because the people in it value basic competence more than creativity. And health care systems, hospital chains and the public don’t place a high value on the difference.
Creativity can be taught. Engineering schools and bio design programs have mastered the “brainstorming” session — a forum in which all ideas have value, and each can be presented in ways that stimulate solutions to unsolved problems.
Creativity training — from the way we approach problems to the way we solve them — has been integrated into almost every field except medicine. To accelerate the creative aspect of education, training and practice, a deep and systematic change must occur. Students must be recruited for their ability to think and educated in problem-solving and innovation. Residencies must go beyond the medical needs of today’s patients and model future practice, including work with robotics, artificial intelligence, genetic engineering and 3D modeling. And insurance companies and hospitals must provide incentives and reward those that push forward the envelope of medicine.
If you want to be treated with a better than a 75 percent chance of success — and if you value excellence as much as kindness — I suggest you demand that creativity be part of the doctor’s repertoire.
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco.