“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/
  

 

3 thoughts on ““Minimally Disruptive Medicine”

  1. 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.

  2. 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.

  3. 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.