The times they are a changing.

Joseph B. Kirsner, MD
Joseph B. Kirsner, MD

I was trained by a giant – Joseph Kirsner – but the giants have all but become extinct. We still have triple threats, but few clinical giants.

Maybe the evidence base has surpassed the eminence base. On the other hand, while there is still hope for clinical giants, there is less expectation.

I’ve been told that medicine is a science, healing an art, and health care a business. All come together in what is becoming “team medicine.” Team medicine does not exclude “personalized medicine.” Indeed, it now “takes a village” to care for patients, predominantly those with multiple or chronic conditions.

Fear not the demise of Marcus Welby. He was a myth to an older generation. Change is inevitable and patient expectations are evolving.

Clinicians will need to adapt to a team approach and become team champions focused on the individual patient. More often than not, several teams need to coordinate around the patient.

While management of hospitalized patients has always involved a team, the approach has also migrated to the outpatient setting. Patients now expect a team approach, but will still hold the captain accountable for the team operations and for personalized outcomes.

There is no irony in the evolution from solo practitioner management to team coverage to provide personalized medicine. The complexity of our health care systems, and the fragmentation of services, requires navigation at multiple levels to optimize and individualize care within – and amongst – medical teams.

I’ve seen research presentations that claim a computer can obtain a better history than most clinicians. Based on the computer-analyzed history, a differential diagnosis and diagnostic plan is generated followed by a personalized treatment algorithm. One could envision our roles as physicians evolving from clinicians to health coaches guiding patients through the pre-determined algorithms.

While my mentor berated the evolving health care systems, Bob Dylan recognized long ago that “the times they are a changin’.” Not necessarily better or worse, but (inevitably) changing. If we embrace the changes, teamwork can continue to improve the care of our patients.

Stephen B. Hanauer, MD, FACG
Stephen B. Hanauer, MD, FACG

Stephen B. Hanauer, MD, FACG



Memorial Tribute to Joseph B. Kirsner, MD, PhD

Video: Bob Dylan’s The Times They Are A Changin’