{"id":1047,"date":"2015-06-15T02:04:34","date_gmt":"2015-06-15T09:04:34","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=1047"},"modified":"2015-08-05T18:44:41","modified_gmt":"2015-08-06T01:44:41","slug":"parenting-medical-disruptors","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=1047","title":{"rendered":"Parenting medical disruptors"},"content":{"rendered":"

\"rebel-without-a-cause-2\"<\/a>Popularized\u00a0telemedicine \u2014 that is, teleconferencing with a physician over one’s smartphone \u2014 worries many critics because it assumes\u00a0patients\u00a0can be evaluated without a physical exam. \u00a0The critics are right that\u00a0those with a financial interest in “disrupting” health care typically minimize the trade-offs. \u00a0Convenience and lower cost are trumpeted, while\u00a0risks\u00a0of misdiagnosis and mismanagement\u00a0are\u00a0waved off. \u00a0The concerns of\u00a0practicing physicians are\u00a0dismissed as self-serving\u00a0and illegitimate. \u00a0Common sense supplants expertise; repudiation of experts, or perhaps a rebellion against them, lies just under the surface. Startup\u00a0culture\u00a0celebrates\u00a0and sometimes handsomely rewards\u00a0brash Big\u00a0Thinkers who don’t let a few practical matters, like the fact\u00a0that diagnosis isn’t always a slam dunk, impede progress. \u00a0Steven Jobs wasn’t the only one with a reality distortion field.<\/p>\n

The tension between professionalism and commercialism isn’t new or limited to medicine. \u00a0Misgivings by\u00a0medical personnel about “Dr. Google” and smartphone telemedicine parallel misgivings by\u00a0attorneys about do-it-yourself wills and divorces, and by\u00a0CPAs about at-home tax return software. \u00a0In each domain\u00a0professionals lament the\u00a0erosion of quality, and their inability to\u00a0provide it, while\u00a0business disruptors revel\u00a0in expanded markets.<\/p>\n

It’s also well accepted\u00a0that providing high quality products or services, and wide availability at the same time, is an elusive challenge. \u00a0Usually it’s one or the other. \u00a0Although the marketplace accommodates\u00a0fine dining and<\/em> fast food, the fiduciary role of doctors, attorneys, accountants, and banks separates these fields from the restaurant business. \u00a0Banking is a prime example:\u00a0no amount of convenience or access make up for uncertainty<\/a> about the safety of one’s money. \u00a0And while profit,\u00a0or making a living, motivates professionals as much as it does the businesspeople who aim to unseat them, only the former<\/a> maintain\u00a0longstanding traditions and ethical codes to put their patients or clients before profit. \u00a0The stale charge that heel-dragging professionals are financially self-serving applies\u00a0far more to\u00a0the gung-ho disruptors themselves. \u00a0Medical care has always been about high quality and<\/em>\u00a0wide availability, which is why health care reform is genuinely hard. \u00a0Trading\u00a0away quality for availability or\u00a0expediency\u00a0is\u00a0simply cutting corners. \u00a0We could have done that all along.<\/p>\n

Smartphone\u00a0telemedicine doesn’t\u00a0currently\u00a0allow\u00a0physical examination. \u00a0There are a range of scenarios (“use cases”) where this makes little difference, and many others where it matters a lot. \u00a0But technology is a moving target. \u00a0It’s a safe bet that remote examination technology will improve, gradually putting this\u00a0concern to rest. \u00a0Criticism of telemedicine is not about what it someday may become \u2014 “Star Trek” style holodecks with virtual physicians? \u2014 but about today’s enthusiasts\u00a0getting ahead of themselves. \u00a0That is, selling science fiction, not science.\u00a0 This creates a peculiar dynamic: innovators speak in vague but urgent tones\u00a0of\u00a0our shiny future and the need for traditionalists to step aside for progress, while critics walk a tightrope between condoning\u00a0exploration\u00a0and\u00a0improvement, and\u00a0at the same time keeping everyone safe. \u00a0This resembles nothing so much\u00a0as parental oversight over a teenager. \u00a0Like good parents, professionals must step aside to allow\u00a0entrepreneurs to try new things, learn from their mistakes, and yes, ultimately make the world better than they found it. \u00a0But we can’t be negligent either. \u00a0Some cool new toys are risky, some\u00a0daring\u00a0adventures bring\u00a0unanticipated danger. \u00a0It’s no coincidence that the language of “disruption” sounds adolescent, and that\u00a0pushback from the disruptors sounds like a teenager complaining that his or her parents are old-fashioned, uncool, and self-interested.<\/p>\n

There’s a direct parallel in my specialty. \u00a0For over\u00a035 years, advocates\u00a0of a neurobiological approach to psychiatry have\u00a0oversold<\/a> what we actually\u00a0know. \u00a0From now-discredited “chemical imbalances” to current talk of circuitopathies, neurobiology enthusiasts dismiss humility (and occasionally\u00a0honesty)\u00a0as\u00a0old-fashioned\u00a0and\u00a0uncool. \u00a0This began with an Oedipal victory over Papa Freud<\/a> in the 1970s, was codified into DSM-III in 1980, celebrated as the\u00a0Decade of the Brain in the 1990s, and has shaped the NIMH and psychiatric research ever since. \u00a0Neurobiology has become the dominant paradigm, a matter of faith. \u00a0But aside from\u00a0a limited range of scenarios (“use cases”) involving\u00a0addiction and bonafide brain injury, it’s vaporware so far. \u00a0We psychiatrists are told to\u00a0think<\/a> neurobiologically, and to\u00a0educate<\/a>\u00a0our patients using\u00a0the language of brain circuitry\u00a0\u2014\u00a0even though it’s often an educated\u00a0guess, and even though it doesn’t actually change our treatment.<\/p>\n

Surely time is on the side of the innovators. \u00a0It’s a safe bet we’ll learn much\u00a0more about the brain, gradually discovering the causes of at least some disorders\u00a0we currently call<\/a> psychiatric. \u00a0Thoughtful criticism of neurobiological psychiatry is not about what it someday may become. \u00a0It’s about today’s advocates\u00a0getting ahead of themselves,\u00a0selling\u00a0wishes and\u00a0half-truths as established science. \u00a0Neurobiology disruptors\u00a0speak in vague but urgent tones\u00a0of\u00a0our imminent bright\u00a0future<\/a> and a\u00a0need for the older generation to step aside for progress. \u00a0Meanwhile, critics play the parental role, walking a tightrope\u00a0between\u00a0encouraging\u00a0exploration\u00a0and\u00a0improvement, while\u00a0keeping everyone safe with care for the brain and<\/em> the mind.<\/p>\n

It’s not easy parenting adolescents. \u00a0Sophomoric self-righteousness, know-it-all smugness, and knee-jerk\u00a0rebellion can be irritating as hell. \u00a0Suddenly, adults are idiots and “just don’t understand.” \u00a0The young resist all guidance and veer toward obvious trouble. \u00a0It’s nerve-wracking\u00a0to hang back and watch this happen;\u00a0to refrain, except in extreme circumstances, from\u00a0wagging a parental finger and chiding, “you have a LOT\u00a0to learn!” \u00a0And all these challenges grow in\u00a0complexity when the “adolescents” are\u00a0actually adults, sometimes even colleagues, and when professional\u00a0expertise and decades of hands-on experience invite only suspicion,\u00a0not\u00a0authority or respect. \u00a0Even if our concerns are dismissed as the bloviation of\u00a0myopic\u00a0dinosaurs, we still\u00a0hope our colleagues, business counterparts, and larger society grow up fast enough to see past the seduction of disruption and rebellion. \u00a0We need to\u00a0weigh\u00a0the real trade-offs we face.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Popularized telemedicine \u2014 that is, teleconferencing with a physician over one’s smartphone \u2014 worries many critics because it assumes patients can be evaluated without a physical exam. The critics are right that those with a financial interest in “disrupting” health care typically minimize the trade-offs. Convenience and lower cost are trumpeted, while risks of misdiagnosis […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4,67,7],"tags":[49,69,70,52,43],"class_list":["post-1047","post","type-post","status-publish","format-standard","hentry","category-current-events","category-medical-practice","category-psychiatric-diagnosis","tag-chemical-imbalance","tag-commericalism-in-medicine","tag-current-events","tag-neuroscience","tag-uncertainty","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1047","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1047"}],"version-history":[{"count":11,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1047\/revisions"}],"predecessor-version":[{"id":1060,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/1047\/revisions\/1060"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1047"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1047"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1047"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}