Friday, June 25, 2010

Disruptive and Eruptive Changes in Medicine

The word “disruptive” usually has a negative connotation. It usually means an unwanted, unwelcome, or unexpected break in normal routines.

But as applied to medicine, the word “disruptive” is now coupled with the word ”nnovation.” A “disruptive innovation” has come to mean doing things in a better, simpler, faster, more convenient, more efficient, safer, usually in a less invasive way.

Often disruptive innovations entail less sophisticated people doing things in less sophisticated settings, sometimes outside of traditional institutional settings or in less traditional ways. Examples would be nurse practitioners treating minor problems in retail clinics, physician assistants taking care of routine matters in a medical office and leaving the complicated to the doctor, primary care physicians using portable ultrasounds to search for masses or abdominal aneurysms, or medical technicians doing modified safe coronary stress tests to diagnose or access coronary artery disease and cardiac function.

But such is not always the case. Sometimes the level of sophistication required goes up, such as surgeons using surgical robots to perform urological, gynecological, or cardiac surgeries. Another example is the use of laporoscopic c instruments to do surgery through the umbilical or other body orifices. And then there is the use of imaging guidance to identify colon lesions, to locate critical blood vessels, to biopsy a remote lesion in a less accessible space, like the retroperitoneum.

I thought of this the other day when a friend had three feet of cancer-bearing transverse colon removed through the umbilicus. She was out of the hospital in four days, with only a 2 inch incision to show for it.

From my vantage point, these new innovations are not “disruptive.” Rather they are “eruptive” in the sense they represent a breakthrough in thinking and safer, better medicine.

However, what may be truly “disruptive” for physicians are the changes imposed in the new reform law – requiring them to abandon and paper for electronic records, compelling them to join “accountable care organizations,” forcing them to forsake fee-for-service medicine, and sometimes subjugating clinical judgment to clinical protocols, clinical algorithms , or “evidence-based medicine” approaches imposed by others.

Some of these new disruption innovations, such as medical homes and team-based medicine, hold promise but for those physicians seeking autonomy and intensely personal relations with patients, there are pitfalls, bear traps, pratfalls, and privacy and security issues as well.

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