Thank you to Kirsten Ostherr and Bryan Vartabedian for inviting me to be a part of Millennial Medicine last month. As the team director of the Robert Wood Johnson Foundation’s Pioneer Portfolio, my responsibility is to seek out new ideas that have the potential to transform health and health care. To do so, it’s become increasingly obvious to my team that we need to get out of our comfort zone of the usual conference circuit and look for opportunities to engage with folks we don’t know very well. Millennial Medicine was precisely that kind of opportunity. (If you have suggestions for other events I should attend, I’d love to hear them.)
One of our core beliefs on the Pioneer team is that there is a tremendous potential for health and health care to be transformed by thinking that transcends traditional siloes and comes to us from other industries and disciplines. More often than not that translates to speaking to or hearing from those who are working in technology. I get it; it makes sense. Because of the times we live in, technological advances are often vehicles for innovation. But technology itself doesn’t equate to innovation.
One of the presentations that resonated for me was from Alexa Miller from Arts Practica. Alexa is an arts education specialist working with physicians in Boston to improve the quality of health care by, in part, better enabling these physicians to engage with their patients through closer observation and deeper understanding of their health issues. And Jay Baruch at Brown University is also — through a humanities lens — educating doctors to see patients differently, to better hear what’s going on in their lives and, as a result, perhaps provide them with better clinical care. OpenNotes — an RWJF grant recipient — opens up a dialogue between physicians and their patients by improving communication from the physician to the patient. What Jay and Alexa talked about flips that and allows that patient perspective to flow back in the opposite direction.
Having attended Millennial Medicine, it’s clear to me that I’d love to hear from more people working in the humanities who could share their insight about issues that folks working in the health sector don’t think about very much.
***Editor’s note: Many thanks to Brian from all of us at the Medical Futures Lab – we loved having you at Millennial Medicine and we look forward to continuing the disruptive conversation!
One of my favorite exchanges at Millennial Medicine was the dialogue between Eric Topol and Tom Cole about Topol’s “4 S’s”: scanning, sequencing, sensors, and social media. Topol argued that these four fields have become sufficiently mature that we can now digitize human beings, and he outlined the positive results of this revolution for patient care. (Our student Amol Utrankar provided a great summary of this and other presentations, for those who missed them. And we’ll be posting videos of all of the talks by the end of next week – watch this space for more details.) But Tom Cole, Director of the UT McGovern Center for Humanities and Ethics, thought Topol had missed a few S’s: Story, Spirituality, and Suffering – all crucial dimensions of the patient experience that came up at different times in the course of the symposium. This led to a wonderful dialogue in which Eric Topol expanded on his argument to say that, indeed, one of the effects of the digital revolution may be that it frees up doctors to focus on the more human aspects of providing health care: human to human contact.
We’re thrilled to report that Millennial Medicine was a smashing success. In the words of presenter extraordinaire Alexa Miller, our speakers “hit it out of the park,” and here’s just one of the many incredible outcomes of the event: Greg Matthews’ map of “The geographic origin of the authors who used the #MMed13 hashtag during the Millenial Medicine Symposium on April 26, 2013.”
It is as exciting to see our reach as it is illuminating to see our gaps. We’re eager to capitalize on the energy of this meeting to reach out to the parts of the globe that didn’t see twitter traffic this time, and to think about how conversations about the future of #meded might look different beyond the red dots. As we will discuss in upcoming posts, a lot of our discussion circled around the relationship between physically present and online experience in medicine. This map provides just one of the many possible entries into this conversation.
We’re eager to hear more of your feedback, from those who attended and those who engaged via livestream. More opportunities to continue the conversation coming soon, and thanks again to everyone who attended – a sparkling audience is as important as a stellar speaker lineup. We were incredibly fortunate to have both.
I want to welcome everyone to Millennial Medicine. My name is Bryan Vartabedian, I am a pediatrician at Baylor College of Medicine. We have a remarkable lineup of presentations that we hope you’ll find provocative and inspiring. We’ve hand selected some of the greatest visionaries and thinkers in medical education and it should be an exciting day. If you came for answers, you may be in the wrong place. Rather than offer all of the answers, we will create questions. We are hoping that Millennial Medicine will begin a new conversation about medical education.
We would like to open up by telling you a little bit about the Medical Futures Lab (MFL), the project behind this meeting. But to do that we have to offer a little background about the changes in medicine that inspired the MFL.
It seems that no matter where I turn I’m surrounded by pessimism concerning the state of our profession. Doctors are discouraged, disillusioned and under appreciated. But I happen to think that this is perhaps the most exciting time to be in medicine. Information and technology are advancing at rates faster than we can understand. Physicians are in the midst of a shift never before seen.
This has lead to something of an identity crisis for us. Everything we understand about what it means to be a doctor is changing.
We are being redefined. There are a number of forces responsible for that.
Technology – The first force pulling on us is technology. Technology has defined every medical generation before us and this generation is no differnet. A lot of what we once did with our eyes, ears and hands has been replaced. It’s been said that in the 19th century we treated symptoms, in the 20th century we treated diseases and in the 21st century we will predict, preempt and prevent disease. Clayton Christiansen calls this the move from intuitive to precision medicine.
Third party forces – Another force shaping doctors is third party control. Care is increasingly under administrative/centralized control through evidence based guidelines and information derived from big data.
Health 2.0. Perhaps the most influential force in the modern redefinition of the physician is the health 2.0 movement. Patients themselves are changing and they are, in turn, influencing us. For the better part of modern civilization our role as physician has centered around privileged access to information and knowledge. But the web has created a type of disintermediation. Patients can do more on their own. They can access information and make certain judgments. They can share information and adjust what they’re doing based on the input of others. And the physician encounter is evolving as a more narrowly defined element in an individual’s quest to understand their condition and get better. This health 2.0 element is fueled by new tools of communication and collaboration
In effect we are seeing a variety of social and technological forces conspiring to redefine the role of the physician. In the words of Eric Topol, our first speaker, we are experiencing a Creative Destruction of Medicine. We are witnessing what he calls the Great Inflection of Medicine.
But despite what Dr. Topol will so eloquently outline, we continue to see, think and work like doctors from 1957. We see medicine in a 20th century construct. And this is because in medicine, our practices and workflows are typically predicated on models shaped by the generation before us. While the physician of 2050 will think and work in a way that can only be imagined by the current generation, we are completely unprepared to deal with what lies ahead. Medical leadership and professional educators need to anticipate and study the issues evolving as medicine undergoes its most extreme transformation.
We must change how we train physicians.
And there are so many challenges
Our human and institutional systems for keeping pace are based on 20th century processes.
Real-time dialog and social transparency are blurring the boundaries between a physician’s professional and personal life
And, for the first time in medical history, physician trainees are more comfortable with the tools of health information and communication than their teachers.
The physician of the 21st century will need an entirely new set of literacies in order to function in this new world. These literacies must be reflected in how we train our physicians. There are many new literacies that could be identified. Here are a few:
Network awareness – Within my generation we will begin to see a move from teaching doctors what they need to know to teaching them how to access what they need to know. Physicians are part of a global network, and accessing that knowledge will represent a key, new literacy.
Input management – Information is increasingly becoming the problem rather than the solution. Doctors need the tools and abilities to manage inputs.
Creation/translation of knowledge into a digital format – The translation of what we know into tagged, retrievable digital content will represent a key skill for doctors going forward.
Mindfulness – And despite how technical we become, we need to never allow our screens to become between us and our patients. We must train our next generation to work with technology in a way that puts the patients first.
I really believe that this is the most exciting time to be in medicine. I’m convinced I was born at just the right time in history. I was trained as an analog physician but I’m a witness to this incredible digital transformation.
Thank you. I’d like to pick up where Bryan left off by talking a bit about how we’ve designed the Medical Futures Lab to respond to some of the challenges he just laid out.
One of our core operating principles is that we are facing complex problems that require broad, multi-disciplinary collaboration among stakeholders located within and beyond medicine. As the historian of science Naomi Oreskes memorably put it in a lecture at Rice last year, “The problems of the world don’t come to us packaged in the form of academic departments.”
With this insight in mind, the Medical Futures Lab aims to overcome the silos that have traditionally separated different institutions and fields of expertise, by drawing on talent at Rice, Baylor, and the various schools of UT Health. And that talent includes both health professionals and innovative thinkers whose outsider approach to health challenges can provide the fresh perspective often needed to come up with novel solutions to old problems.
We believe that the unique challenges of practicing medicine in the digital age come from the complexity of medicine, as well as the complexity of digital media. That’s why we have formed a collaboration that brings together media scholars such as myself, along with artists and designers, to work with health professionals.
You’ll see this approach reflected in the lineup of today’s speakers, several of whom are not medical professionals, but have important things to say about the future of medical education, nonetheless.
It’s also a great tag line: As Bryan put it in a 33 charts blog post earlier this year, “An English professor and a pediatrician walk into a bar…”
The purpose of bringing this multidisciplinary team together is to train the next generation of physicians to tackle the challenges of practicing medicine in the digital age. And we believe this training requires both critical thought and media creation.
Some of the topics we’re focusing on include social media, quantified self, patient engagement, big data, mHealth, digital ethics, doctor-patient relationship, emerging technologies & health disparities.
Our approach draws on the tradition of medical humanities and infuses it with digital media theory to train our students in a field of practice we call digital medical humanities.
Our emphasis is on cultivating digital literacies – skills for optimizing health professionals’ use of digital media to improve their practice and enhance their communication with patients. And we consider education to be a lifelong engagement, so we are developing this content for all stages of medical education – from pre-med through CME.
I’ll give you a couple of brief examples of courses from this past year. ENGL 273, ENGL 278. I’m delighted to say that a number of our students – future thoughts leaders I this field – are here today, say hello! And check out their public thinking on our class tumblr. Special thank you to the Office of the Provost Faculty Initiatives Fund for their support of these classes and this symposium.
Almost half of our Rice university undergrads plan to attend medical school or go into biomedical research. So we see them as our starting point for fostering new digital literacies that they will bring with them into their medical careers. But we also see these courses as modular units that can be incorporated into medical school, residency, and beyond through online, open-access platforms. Watch the Medical Futures Lab blog for more about this in coming months!
We also believe that education transcends the traditional lecture hall setting, just as healthcare transcends the clinical setting, so I’d like to wrap up by telling you about one more of our exciting projects at the Medical Futures Lab that engages both providers and patients as 21st century active learners.
As Howard Rheingold argues in Net Smart, learning by doing is especially true when it comes to participatory media. To this end, we have created the Medical Media Arts Hub with support from the Rice University Arts Initiative Fund through the Office of the Provost. Extra special thanks to Caroline Levander for her support of this endeavor.
The Medical Media Arts Hub is an innovative online platform & media creation space where students help medical professionals amplify their health messages through creative design. Students with creative skills get to work on real communication, visualization and information problems with health professionals and patient stakeholders, getting regular feedback on the design process from engineers, creative professionals, and other members of the health community.
Health professionals get reverse mentoring from digital natives, patients actively shape their relationships with providers through the collaborative design process, and patient engagement leads to better health outcomes. Everyone wins!
We’ll be piloting our first Media Arts Hub projects this summer, so stay tuned for more as the Hub develops. Thank you for joining us for the inaugural symposium of the Medical Futures Lab. And before we turn to our first speaker, we have a brief announcement from Brian Lang, the co-founder of one of our important community partners, Health 2.0 Houston.
If you can’t join us in Houston, follow the Millennial Medicine symposium this Friday April 26 from 8:30-5:15pm CST on twitter at #MMed13 (and send questions for us to feed to the speakers), and watch the livestream at:
Let us know what you think!
There’s been a brilliant last minute addition to the lineup for this week’s Millennial Medicine. Greg Mathews (@chimoose) from Austin’s WCG Agency has undertaken a special custom-designed, artisanal analysis of online dialog happening around medical education.
WCG is one of the world’s leading authorities in social listening. They hand fashion software that listens to the conversations happening around us. In this case we will learn what’s really happening around the #FOAMed and #MedEd hashtags. Who’s there, what are they talking about and where does it seem to be going. Public dialog surrounding medical education is virgin territory and we hope this will lead to as many questions as answers.
Greg will be live on the #MMed13 stage beginning at 3 PM CST. If you won’t be with us in person, you can catch him on our live stream from any point on the planet.
We’re thrilled. Thrilled because this is happening at Millennial Medicine. We’re double thrilled that we’re facilitating one of the first granular analyses of social dialog around medical education. And we’re triple thrilled that we can bring this to you from the heart of the largest medical center on the planet during one of the most forward thinking meetings in MedEd.
I’d like to tell you more but we’re busy setting up for the big show.
If Greg and the team at WCG come up for air before Friday, we’ll try to tease you with some of what they’ve found. If not, you can catch all of the thrilling details at Millennial Medicine.
In a previous post, I wrote about Ted Gup’s critique of the current rush to organize human differences into diagnostic categories, which he published on the heels of the CDC’s recent report that 11% of U.S. children are currently diagnosed with ADHD (see “Diagnosis: Human”). It’s interesting to consider this critique in light of the DSM’s history, and in light of projects to automate diagnoses using computers, all of which produces some intriguing questions about the future of EMRs.
Some readers may already be familiar with the vagaries of how the DSM has treated “homosexuality” over the years: it wasn’t until 1986 that editors completely removed it from the DSM.
In the late 1960s, one of the DSM’s previous editors, Robert Spitzer, developed a computer program intended to automate diagnosis. Called DIAGNO, the program was envisioned for use during intake at psychiatric facilities. Spitzer’s basic premise was that, since clinicians employ a decision tree to arrive at a differential diagnosis, and software code also uses decision trees, a computer program could be equally if not more precise than humans at determining diagnoses. DIAGNO went through three versions as Spitzer fine-tuned it over the years, aiming for a program that could one day skip the clinical encounter altogether.
As far as I’ve been able to figure out, DIAGNO remained a dream that was never implemented; however, it’s interesting to note that Spitzer was building on other researchers’ programs to automate recommendations for which drugs to use to medicate specific disorders. One of these was used in the late sixties at the University of Texas Medical Branch in Galveston. (Please comment if you have any additional information on DIAGNO’s implementation!) The dream of automating diagnoses lives on, however, whether in technologies intended for use in the home such as SCANADU, which would diagnose medical conditions, or those for use in clinical settings. In the latter category we could include a fascinating project that attempts to integrate findings from cognitive science to help automate psychiatric diagnoses, so that diagnoses can be reached through a computer program analysis of a patient’s narrative (see Cohen et al., “Simulating Expert Comprehension”).
I wonder what Ted Gup would say about this latter effort. In this dream of a future where diagnoses are automated, his narrative about his suffering might, when analyzed by software, be diagnosed as a condition suitable for treatment. Do we want this future where computers can diagnose? What happens when EMRs are based on diagnostic categories that can’t reflect the particular exigencies of their historical moment that drive the diagnosis?
We’re just about a week out to Millennial Medicine and we’re pleased as punch to announce that we have MedCrunch on board as a media partner. They’ll be front and center writing, tweeting and creating as we envision the future of medical education. If you’re not familiar with MedCrunch, it’s a great online publication that covers some of the different angles of medicine, technology, and physician lifestyle. The Austria based group has been making the rounds here in the States at SXSW, HxD and….Millennial Medicine. Check ‘em out. We’re thrilled to have them aboard.
And if you haven’t registered for Millennial Medicine, seats are filling up quickly.
I’ve been thinking a lot about how to draw the attention of physicians and medical students to debates over the diagnoses that they often accept as self-evident, particularly because these diagnoses are intricately interwoven into electronic medical records.
These questions became particularly relevant when I read a reaction to the recent CDC release about ADHD, which is now diagnosed in 11% of U.S. children. In a New York Times Op-Ed piece (“Diagnosis: Human”), Ted Gup, a fellow of the Edmond J. Safra Center for Ethics at Harvard University, described a set of personal experiences that made him critical of the current rush to affix psychiatric diagnoses to characteristics that are perhaps simply part of what it is to be human. When his son displayed qualities that other eras might have labeled “rambunctious,” our era stepped in with a diagnosis of ADHD, for which his son received, in lieu of talk therapy, the standard treatment: amphetamines.
At the age of 21, his son was found dead of a lethal mix of medication and alcohol. Gup views the death as a logical outcome of his son’s experience, where medication was not only the accepted tactic to address those qualities society labeled as a “disease,” but was also used as part of a culture of success, where, particularly among college students, amphetamine use is rampant. As further evidence of why the ballooning of diagnoses is a problem, Gup offers up the example of his own grief, an all-too-human and understandable response to losing his son – and which, according to the latest edition of the DSM, is diagnosable under the category of depression, and therefore treatable with medication.
Gup’s impassioned critique led me to consider how diagnoses are integrated into EMRs.
In my next post, I’ll return to these questions in light of ongoing attempts to develop computer programs that could automate diagnosis, both for medical and psychiatric conditions. Let me know what you think.