We all know what it’s like to go to the doctor’s office in 2019 in the U.S. The entire affair tests our understanding of time. Copious amounts of it are spent in waiting rooms, sitting in silence, only for time to rapidly slip away once in the exam room, as we attempt to connect with our doctors in hurried conversations. Doctors type away, back turned, staring at a computer screen.
After spending the last year in clinical rotations as a medical student, I can tell you that today’s reality of providing care—rushing between rooms, skipping meals, and spending more than 70 percent of our time in front of computers entering data, all to meet productivity goals—is not what we physicians chose for ourselves or for our patients. We can only hope that solutions to these problems are in our future.
Diagnosis, a new Netflix docu-series, may offer a glimpse into that future. Featuring Lisa Sanders, a Yale internist and journalist (who once consulted for the medical drama House), the show is based on her longstanding column of the same name for the New York Times Magazine. Her columns walk through meandering medical cases that have already been solved, often by a doctor drawing unusual but accurate conclusions, or through a kind of eureka moment. Each of the seven episodes features a medical mystery, but that’s not the entirety of the show: Sanders, in her words, “wanted to take the next step” with her column. Within the first few minutes of Diagnosis, she raises the possibility of harnessing the wisdom of the digital crowd—the global readership of the Times—to diagnose medicine’s most difficult cases. Referencing the practice of medical teams “rounding” on patients together in hospital wards, she asks in a later episode, “what if we could make the room a little bigger?”
The show offers an idealistic picture of what medicine might look like if it were decluttered of its bureaucracy, giving doctors and patients more time together. Little, if any, time on camera documents Sanders wading through electronic health records, or fighting with insurance companies over the phone (to be fair, this would not make for the greatest television).
Instead, efforts are spent toward stepping into the shoes of patients like Angel, whose illness traps her in her home and threatens to derail her nursing career before it even starts. Conversations are focused on grappling with medicine’s gray areas—weighing the difficult decision around how to end the seizures a patient named Sadie experiences: to go with implanting an experimental neuro-pacemaker versus submitting to a barbaric, but likely curative, brain surgery. Space is also created to empathize with the social implications of a stigmatizing diagnosis, like Ann’s eventual diagnosis of functional neurologic disorder as a woman of color.
Combined with a passion for understanding the human body, it’s those pursuits—connecting with patients and offering them treatment that reflects their own personal needs and circumstances—that drew many of us to this profession in the first place. All too often, however, they are relegated to afterthoughts in the churn of modern medicine.
Watching the show, I wondered if medicine’s mishaps—a doctor, in Lashay’s past, poorly explaining a diagnosis of a digestive disorder called rumination syndrome, to take one example—were rooted in a scarcity of time between patients and their doctors.
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In his recent book, Deep Medicine, cardiologist and digital health researcher Eric Topol charts a path to reclaim the lost time in modern medicine that makes all the difference in in Diagnosis. Topol foresees a future in which artificial intelligence becomes a fixture in medicine, processing vast amounts of data, clearing away clerical debris, and—yes—helping physicians make diagnoses through pattern-recognition in EKGs and chest X-rays. This will end an era of what Topol describes as "shallow medicine," characterized by a scarcity of time and presence that, all too often, leads to misdiagnosis and mistreatment.
Topol told me that “in 10 years, there won’t be any keyboards” in the exam room, with computers seamlessly charting notes and allowing physicians to interact with their patients face-to-face once again. He sees doctors spending more time with patients during appointments and thinks that those visits will be “reserved for more important matters” that warrant close conversations (as opposed to routine matters, which could increasingly take place over the internet). Topol also shared that he himself had watched Diagnosis, and noted that “the theme that is consistent between the show and Deep Medicine is how important care, empathy, and the patient-doctor relationship are” rather than “the specific diagnoses in each episode.”
In the aggregate, Diagnosis and Deep Medicine seem to outline a new role for the physician. Historically, medical education has placed a premium upon transforming its students into walking repositories of clinical knowledge, reinforced by increasingly high-stakes exams. But both Sanders and Topol viscerally show us that this transformation is no longer truly possible, nor perhaps desirable.
Their efforts, in a way, highlight the fallibility of the lone doctor, armed with only her knowledge to stave off human disease. Yet they also exonerate her of the outdated societal expectation that doctors must know it all. Instead, they seem to suggest, doctors ought to be highly trained curators of that information—knowing how to access it, and communicate its relevant pieces to their patients. And both today and in the future, perhaps most importantly, our most valuable skills will be in empathizing and connecting with our patients.
Ultimately, Diagnosis suggests that we in medicine have more work to do, to keep up with our evolving role in caring for our patients. Although Sanders herself, in a recent Reddit AMA, describes her role on Diagnosis as a journalist first, she offers a good start toward rising to that challenge for doctors. She sifts through the noise of the crowd for her subjects; she offers expert opinions, and walks with them through medicine’s uncertainties. She is a curator, a confidante, and a partner for her subjects. Although perhaps not so practical today, she, for a few hours, slows the frenetic pace of daily medicine, and offers us an antidote to the collective burnout experienced by our patients and physicians. In doing so, she and Diagnosis gives us a reason to be hopeful for the future of American medicine.
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