We Are the Borg. You Will Be Assimilated

This is an email that I shared with a number of colleagues. I think it aptly reflects the status of medical education, practice and research as it is today. I have included it here, unchanged. Comments always welcome.

​I have written a few blog posts about this topic. I have commented on how present day medical schools are NOT preparing medical students for a likely, very tumultuous and uncertain future.

Although still expensive, medical students (especially those in schools where they pay $50,000 tuition and upwards) should be given handheld US devices and digital stethoscopes from day one. These students should have special classes on how to use the Internet and plug-in apps to increase their productivity and validate their actions. Every hospital needs to build a portal (yesterday) for allowing all doctors to see patient results on their mobile phones, and to be warned of any undue changes. Consulting requests and replies all need to be handled via a web interface, viewable from anywhere.

The senior teaching staff needs to select and/or build a digital curriculum that truly covers everything a student should know. These days, with YouTube, there is no reason that students should have to attend crowded classes to hear basic level lectures (which in some cases are repeated year from year by a lazy professor). Anatomy can be much better demonstrated in 3D than in carving up a hapless cadaver.

Medical students should get involved with medical research projects from day one of their studies. They should be shown how available public data are just waiting to be analyzed and used to better patient care. And yes, medical students of today should have focused training in doctor-patient communications. Many doctors I know lack significant compassion. So, it is critical that this be a course that you MUST pass, and that in final exams, you MUST demonstrate high quality human interaction skills. And this should continue into residency. Any surgeon that does not know how to properly talk to a patient should not be allowed to graduate.

One of the fundamental mistakes that are made when designing an EMR, is that the development team tries to create a monolithic monster that answers all needs from day one. Then, between bug fixes and remaining requests from the initial design specification, it can take eons until new changes are made. Instead, one can start with a series of relatively isolated technology tools, that are linked only by a common backbone of patient data. As long as each internal table that contains medical information, has an identity key that links back to the patient profile, then new apps can be added all the time, with little chance of bugging up existing or future tools. This is really not hard to do, and I know this because I did it.

Anyone who is waiting for the tech revolution to fix all of medicine’s problems is going to wait a long time. Anyone serious about making health care better should start devoting time and resources to the new world of medicine, and in this way, be at the forefront of medical tech. If you personally have no background in medical tech, you have two choices: (a) soon become obsolete or (b) learn the new world. I am 53 years old and I have been programming for over 3 decades. And still, I will be getting myself a tutor to help me get up to speed on the latest innovations from Microsoft. And I may use this tutor, not just for a few weeks, but for a couple of years, to help me stay on top of things. This will not be cheap. But I realize that I have no choice.

Doctors like to feel as if they are in command of their knowledge base and that no one can replace them. Any doctor who still thinks so, is living in a cave. I know too many such doctors. Needless to say, they are not included in this email (or its BCC list), simply because they would not understand its message and/or they think too highly of themselves to seriously consider what I have written. I fully appreciate just how big and fragile many doctors’ egos are. But the time has come for everyone to swallow hard and put the past in the past, and start to study the new world that is coming upon us.

Have a great weekend, Shabbat Shalom and thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.