Default is the status quo. It is cookie cutter medicine. It is flowchart medicine. It is brainless medicine.
Default medicine is continuing to prescribe Paxil when studies show it to be no more effective than a sugar pill, default is telling a diabetic patient to increase whole grains when you know it should be no grains, default is refilling that Omeprazole prescription for the 24'th time disregarding it's potential for long term ill effects. Default is Lipitor, default is the pharmaceutical based medicine of yesterday.
Medicine by Design
Design is using your observational skills as they were intended to be used, it is the art of medicine... The lost art of medicine.
Design is structuring your treatment plans around what is best for you patients. It is taking the time to listen to their individual needs and setting aside your prescription pad. It is checking in, instead of checking boxes. It is often the path of greatest resistance, which is also the path of greatest reward. It is tuning into the you that decided to go into medicine in the first place. You know, the ideologue, the one who believed in health because life is finite and beautiful and people owe it to themselves to live healthy lives.
Design in not by itself the default path. It is the intentional path.
Lately, I have found myself increasing frustrated by many of my patients general state of poor health, it was during a common rant, and the reading of a wonderful article, that I was finally able to identify the cause of my problem:
I had spent years of my life living and practicing medicine by default, and not by design. My life outside of medicine began to reflect this as well. Everytime I paid my mortgage and my car payment, renewed my cable television contract, recited the same rote and thoughtless sayings in church. I was living life by default.
Wash, rinse, dry. Enter, listen, prescribe. Work, eat, sleep... and repeat!
As humans we crave routine, you will know this if you have kids. My children thrive with routine, but too much routine and you create a good factory worker, which won't take you too far now adays.
Education by Default
Horace Mann in 1843 created a free public school system that made sense for the industrial age in which he lived.
The factory line was simply the most efficient way to scale production in general, and the analog factory-model classroom was the most sensible way to rapidly scale a system of schools. Factories weren't designed to support personalization. Neither were schools.
Medicince by Default - See and Treat - Factory Line Medicine
Around the same time, in an era of factory line education, was probably conceived a similar system of factory line medicine.
Line those patients up, go down the line, write the prescription, send the bill, and please whatever you do don't call me in the morning.
Medicine, just like Ford automobiles, or the school system of Horace Mann was about efficiency. Not necessarily about patient outcome or patient satsifaction.
The rise of Design
We are living in profound times. Maybe it is because of technology or systems within the new technology such as Facebook, but more than ever the system of 150 years ago is being challenged. We can see it in our courts, we can see it overseas, we can see it in our schools.
It is time to see it again in our lives.
If you find yourself frustrated in your practice try these steps:
- Decide to practice evidence based medicine by design.
- Seek integrative treatment plans that are individualized to your patients.
- Extricate yourself from a factory line clinic if that is where you work. Seek to either create or work within a system that solves problems instead of kicking the can down the road.
- Focus on patients, not profit, and you (and your organization) will find what you seek.
- Read beyond medical journals to get the big picture, aim to find a solution not a band-aid. Avoid big pharm's seductive (yet selfish) recommendations.
- Resist the treadmill that is the default.
Once you see how your unique ideas can drastically improve your patients lives you will start to trust your instincts. As a new grad this is hard, we tend to revert to default out of fear. As a PA it is even harder because we have a supervising physician. But this is just an excuse.
Trust yourself, bring your art back into medicine, rekindle your passion, and be part of the movement to take back medicine from those with the biggest advertising budget and give it back to those who deserve it most.
Chose to practice medicine by design not be default!