A friend recently told me his daughter has been accepted into medical school with hopes of becoming a pediatrician. Along with this accomplishment will come $250,000.00 in debt.

I could not help but think of how her educational experience and future practice model will be so different from those who hold leadership positions in medicine today. Tablet computers will replace books and she will live in a 24/7 wired world.

I came to the medical blogging world a number of years ago as a patient looking for an answer to the question: Why does my doctor sound like a very bad advertisement for the latest drug? Sadly, on a number of occasion’s doctors and nurses have physically blocked me from leaving the exam room demanding I submit to additional test, or take the latest branded drug, due to my insurance. In one instance a doctor was very blunt telling me I was taking food from his children’s table.

That early blog world of doctors and patients ranting about each other has morphed into a sophisticated academic world with thought leaders and venture capitalist. A doctor’s reliance on drug reps and journal articles represents an attitude that has become out of date and simply will not work today, or in the future.

NNT has entered the vocabulary of most patients. Despite the best efforts of the pharma spin machine legal settlements are now widely publicized. Pre-publication debate of major guidelines by a learned doctor/patient base is now the norm. Technology has not only increased the amount of information available to patients and doctors, but also changed what has been a sacred relationship.

Computers drive revenue in what has become a medical industrial complex where medical leaders are touted as titans of industry. Time has become a resource that is now measured in seconds, not minutes with a patient.

Medical school, with an abundance of applicants, appears to have taken on the role of educating our future doctors while wishing to participate in their future earnings through high tuition cost supported with school sponsored loans. Now medical academic centers are lobbying government to increase continuing educational requirements in order to trap and hold students.

Debt service will drive the decisions this young woman makes about her professional career and her personal life. A spouse and children may be postponed due to financial issues.

Through the noise of the technology. The constant din of information. The pressure of the practice or corporate employer I wish for her success and the ability to set the tablet computer aside with all of the patient’s information and nurses notes, and ask one simple question: How can I help you today?

This is the essence of medicine.

Steven Lucas is a long time commentator on a number of medical blogs.

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