“Minimally Disruptive Medicine”

Hannah Fields, a med student at Mayo who has just begun blogging, offers a provocative essay on medical care that “fits”—not the doctor’s beliefs or even objective medical evidence, but “the patient’s reality.”

 She writes: “In the real world, we must use different tools and ways of practicing medicine to determine the shared goal  with as much agreement as possible between doctor and patient, and to find treatments that are within the capacity of the patient and can be accomplished using the patient’s available resources.” http://minimallydisruptivemedicine.org/2010/03/26/hannah-fields-discusses-mdm/  (Many thanks to vmontori for calling my attention to Hannah’s blog on twitter. http://twitter.com/vmontori

Hannah calls this “minimally disruptive medicine”:

“In minimally disruptive medicine,” she writes, “the most important objective should be to treat or manage disease so that the patient has the best chance of leading the life that he or she wants with minimal disruption due to disease or treatment. The practice and pursuit of finding a treatment that fits by shifting the doctor and patient goals as well as by addressing the patient’s capacity to cope with or adhere to a treatment is the practice of minimally disruptive medicine. . . I recently began the long journey of medical school because I want to spend my life helping others to address health problems in order to use time and energy towards other priorities, and in minimally disruptive medicine, I hope to find a fit.”

I realize that this is a controversial idea. We tend to assume that the patient should and even must do what would be best for his or her health-- whether or not this disrupts the patient’s life. But consider an extreme counter-example: While trying to find a primary care physician about a year ago, I visited a young woman doctor who told me: “You must change your job. Being a writer is too sedentary. You must find work where you get more exercise.."

Objectively, there was a large kernel of truth in her comments on my career. Writers often find themselves manacled to their computers. They sit for long hours. But if you love writing, you are willingly tethered to your computer. Writing is addictive.  No one forces me to spend so much time researching, writing posts, or answering reader’s comments.

 Obviously, there is a happy middle ground between giving up my career as a writer in an attempt to become a Yoga instructor, and simply watching my muscles atrophy. Stretching, physical therapy, and gardening all help, and I do all three. But no, I’m not willing to do something that would disrupt my writing life.

I suspect that, as medicine becomes more “patient-centered,” Hannah is onto something that other young physicians, residents and med students are beginning to thinking about. I can’t help but remember a young doctor (maybe a resident) who raised his hand  at a conference where  I spoke at Lenox Hill hospital here in Manhattan a a year ago He xpressed his view that he felt he should be giving his patients the treatment the patient wants (as long as it doesn’t harm him or her) , whether or not this is the doctor’s first choice. His argument was that  the patient must be comfortable with the treatment. "If the patient isn’t happy with the treatment, I’m not serving her well."   

I was a liattle taken aback.  I didn't know what to say,. I wish I had gotten his name.

To read Hannah’s entire blog, go to  http://minimallydisruptivemedicine.org/2010/03/26/hannah-fields-discusses-mdm/   

 

Comments

[Maggie Mahar]

Dinosaur #2 and Chris

Dinosaur #1-- My interest in the idea really isn't tied up with the acronym, but rather with my own attitudes as a generally reluctant patient.

It's not that I don't appreciate medical science. But I see it as a last resort.

See my response to Chris.

Chris--

Yes, there are no new ideas under the sun.

But some fall out of favor, and then we re-discover them under different circumstances.

And of course young people are always disovering things. It's fun to watch that . . I envy people who are about to see Casablanca for the first time, read Jane Austen for the first time, become parents and fall in love with a child for the first time. . .

And I do think that today's generation of med students are likely to be somewhat more skeptical about all of the technology. (Some complain that no one teaches them to diagnose the old fashioned way--listneing to the patient, even placing hands on the patient!)

Now if we could just change med school education . . Still have to write part 2 to that post.

[Chris Johnson]

I agree with old #1 dinosaur -- maybe I'm dino #2. It is interesting to see how things have come around in a circle.

My grandfather graduated med school in 1903. He had very few treatments that worked. My father graduated med school in 1944. He, too, didn't have much besides morphine, digitalis, and a lot of nostrums that didn't help at all. When we docs finally got some treatments that did good, some of us forgot about doing as your young blogger describes. But a lot of docs didn't forget those age-old practices, they just didn't get much press about it.

Perhaps the next generation of docs can find a successful blend. It is kind of cute to watch them discovering the wheel again.

Since I'm Mayo Med School class of '78, it's also fun to see how the kids are doing.

[#1 Dinosaur]

Excuse me for the snarkiness, but all I can say is, "Duh!"

I love the terminology -- and the fact that its acronym is the same as your book did not escape me -- but the concept is old news. I've been doing it for years.