Our profession is moving toward identifying these doctors and promoting their behavior to the entire field.
There's a study that showed lower heart attack mortality when all the "top" cardiologists were out of the hospital attending a cardiology meeting. Too many confounders to make any real conclusions from that, but it lines up with my point.
Of course, if your child has a serious life-threatening and/or rare disease, then you want her to be treated at a vanguard institution like the one you took yours to. No dispute from me on that one.
But in the system as a whole, we make the most difference reducing complications of cardiovascular disease, sepsis, pneumonia, COPD, and kidney disease (which are orders of magnitude more common). And we're starting to find out how to identify doctors that do it better, with fewer complications, and with much higher efficiency than others. I think those are the best doctors and it's what I'm striving to be.
This. I think I've even posted about this here before. This has been my wife's experience too (surgeon). She trained with highly regarded academic surgeons that set the treatment recommendations and standards for her field. Then during her job search she went to a center with, well, surgeons not at all academic and she had a life changing moment because she realized their operations and outcomes (utilization, efficiency etc.) are far far better. At the academic centers you are recognized based on your research and publications, not on your surgical skills. These academic surgeons with relatively little experience are setting the standards for how the operation should be done and what the treatments should be. This is not at all recognized in her field unfortunately and is quite literally harming patients every day because of substandard treatment standards.
Perhaps it's not a perfect analogy, since it sounds like the academic surgeons are maximizing the wrong utility function (publishing / research).
I'd say a good combination of both academics and skills are needed. As another anecdote, where I am in school they have tried to teach us better clinical reasoning and procedural skills rather than solely preparing us for board exams.
The way I see it, your research and academic pursuits can wait until you have a good clinical background. You only have one chance to fully immerse yourself in the practice of medicine (residency), so why dilute that?
[NB This is in addition to the very high academic standards that are required for places at medical school].
I have a friend who is an eye surgeon. I'm definitely better at playing guitar and piano than him, probably equal at things like juggling and card tricks, but absolutely inferior when it comes to cutting people's eyeballs apart.
It doesn't invalidate your point completely, but just because someone is good at plaiting hair doesn't mean they'll be good at surgery!
Being a surgeon is more akin to performing arts. I.e you cant read your way to playing an instrument, you have to practice playing it.
the "best doctors" in my eyes are the ones with the best outcomes,
lowest utilization, highest efficiency and highest patient
satisfaction.
I think those are the best doctors and it's what I'm striving to be.
Also, have you seen this article? It might interest you: http://www.newyorker.com/magazine/2011/10/03/personal-best
There is some name for this apparent statistical paradox, but I forget what it is. In any case, the main problem with your criteria is that the "best" doctor would be one that treated only the healthiest patients. They would have low utilization, high satisfaction, good outcomes, and very good efficiency.
I think you want that in a doctor - a capacity and preparedness to fight the system when it is wrong, unfair, of hurting your patient. Is that a creative skill? I don't know but I doubt it's born out of conformity.
Incidentally I know Dr Marshall, he's an academic at my medical school. He actually paid me to teach him and his team Ruby.
Also, for every patient and family that I meet, I explain right away that the only promise I make is that I will be honest, upfront, and clear when I'm talking to them; that I will give them my best effort. This has served me very well and I've won numerous local accolades because of it. It also softens the blow when something goes wrong, even when it's my fault. When I was a resident, I frequently had patient's demanding to speak with me instead of the attending because they trusted me more.
Keep in mind that I'm a hospitalist/intensivist, so I don't know if things will necessarily generalize to the primary care/office setting.
In the far off rural areas where connectivity is almost nil,The doctors rarely go to the hospitals and the doctor's assistant does more work,becoming at par with the doctors in a few years.
Knowing that my daughter wouldn't be here today without ECMO, I take issue with this assertion.
Edit: She was born with severe MAS and her lungs were practically non-functional. ECMO was the only way she had time to fight the infections and start breathing. She spent 12 terrifying days on ECMO and then 2 more weeks on ventilators.
Also, a significant number of my investment gains originated from stuff I read here (bought a bunch of Monero when it was $0.45/unit, for example).
Finally, I learned a little programming (mostly Go and C++) to automate some stuff at work and home (reports, backups, email notifications and things like that). HN is a reasonable litmus test for what people are using to do stuff like this.
No knock for learning. But if you want to get maximum bang for your learning buck, focus on higher level stuff with lots of third-party libraries that integrate with the things you want to automate, ideally with a interpreter REPL for exploratory coding.
\shrug. Hard to know.
I think that this is truly what made my father be not just "technically good", but a physician who could solve his patients' problems: he made an effort to understand their perspective, and adjust his treatment accordingly.
I've observed him interact with patients sometimes, and his effort at creating empathy was quite noticeable. It's particularly fascinating to watch with children.
I agree with you though that efficiency, and also just honing one's internal sense of what's going on inside a patient's body is important. My dad was department head at a first-world hospital. But every year he would go on a charity mission to some third-world place for two weeks and treat patients there. With essentially no modern technology (in fact, operations might have to performed in the shine of a flashlight), you are really forced to work with your instincts. I think these trips benefited his first-world patients just as much as his third-world ones.
If the standard of success for a gifted grade school kid is to be a Nobel laureate, that's a little warped.
My grandfather was one of the smartest guys I ever met. Through the circumstances of fate, he couldn't get education beyond the 8th grade. Yet he tutored my mom in calculus and did all sorts of good things for people. By any standard of mine, he lived a long, fruitful and successful life... yet he's a failure in the debate of an article like this.
I wish her, you, and the rest of your family the best.
My daughter is being treated for Leukemia by some amazing doctors at Boston Children's Hospital. To my knowledge, none of the health care professionals at this world-class institution have won Nobel Prizes in medicine. All the same, for my daughter's sake, I'm still glad they hit the books for a couple decades.
There are great honor and value in doing an important job consistently and well. This idea that a life is wasted if you don't remake a field in your image seems hollow when these prodigies often end up with the power to save lives.