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Beyond 7 minutes

I trained as a Family Doctor so that I would be ready to help patients with any challenge. The old school family doc used to take that skill set out into the community on house calls, sports sidelines, and town hall meetings. At some point the job description was boiled down into a job that started and ended with a 7 minute office visit. That setup is not good for patients, and it's not good for doctors. In this column I hope to start to push the boundary of where the doctor patient interaction takes place - onto the page, into the community, and beyond 7 minutes.

Who owns health care? Part 1: The brain trust

Humans have always and will always suffer from disease.  We live in a world with radiation, toxins, stress, and trauma. By their nature biologic organisms break down over time. As long as there is disease there will be room for healers.

The Medical Profession

Healers come from different traditions and philosophies. As a Western trained medical doctor, I can speak from my experience becoming a physician. 

During or after an undergraduate degree a doctor will study the “pre-requisite” material to enter medical school. This includes physics, chemistry, and biology in addition to some soft science like psychology and philosophy. Then a student must apply this knowledge to a standardized test called the MCAT or Medical College Admission Test. This allows entry into one of a few hundred medical schools across the country where a student will be immersed in the art and science of working as a physician.

Most medical school graduates will go through a residency training program to specialize in a specific field of medicine. They will apprentice with other doctors in their chosen field to learn the skills of the trade. A pediatrician will necessarily learn a different skill set from an orthopedic surgeon.

There is also an indoctrination process where one learns the subtleties of providing a specific type of care. For example, residency is where family doctors learn how to manage competing demands in a busy clinic day or where a surgeon hones her skills speaking to a patient before and after surgery.

Knowledge & Power

Undoubtedly the physician training process is long and challenging. Many doctors leave training with educational debt, as well as the opportunity cost of starting a career a full decade or more after their peers. Most graduates justify this sacrifice by acknowledging the privilege of caring for another human but also the relatively high earning potential in the field.

Throughout medical education there is an incredible amount of information transfer. From book to brain, from teacher to student, from attending physician to resident physician, and from lived experience to cultivated wisdom, this brain trust holds a large amount of knowledge, and through that, power.

Barriers to Knowledge

In our modern medical system gaining access to that knowledge is often difficult. There are cost barriers, communication barriers, cultural barriers, and convenience barriers to name a few.

Over the next few months we will explore the question of who this knowledge belongs to. Is it the physician who chose the path of healer? Or is it the patient who requests the care and contributes to the fund of knowledge through their experience of illness? Likewise, is it our government that provides for our communal well-being through schools, infrastructure, and public health? Or is it the private companies like insurance groups and hospitals who control the flow of money through our health care system?

It is through questions like this that I hope to distill a better sense of why our health care system works the way it does and how we can make it better.

Oren Gersten, MD