Another Doctor’s Day approaches, and much has changed. I’ve been in practice for a decade now — the blink of an eye — and the dizzying array of medical knowledge that has rolled out in that time is incredible. 

The role technology plays in diagnosis and treatment. The move to interprofessional team-based care. The experiments with different funding models. The shift from health to wellness. Expectations around convenience because sometimes, it’s more patient-centered, sometimes it’s not. The big idea then was patient-centered care; now it’s person-centered care. System stewardship and quality improvement. Outcomes and population health.

The health care lexicon is changing. Value-based funding. Big data. Artificial intelligence. Multi-morbidity. Payment reform. Wearables. Expanding scope. Social impact bonds.

Our youngest generation is more plugged in than ever before. To them, the new lexicon and the paradigm it represents is as natural as breathing. To them, the future is now. Because unfamiliar as the lexicon is to many of us, that lexicon represents a reality that is already happening. Wearables, artificial intelligence, big data, social impact bonds — it’s all here now.

Disruption is the latest buzzword, but the fundamental meaning is the same: change. Everywhere you look across Ontario, the country or even around the world, there is growing pressure to transform health care — how it’s funded, how it’s delivered, how it’s even conceived.

To ignore disruption is to expect to drive forward looking only in the rearview mirror. Impossible.

Medicine, a profession thousands of years old, is under pressure to change.

Yet.

Plus ça change, plus c’est la même chose.

My oldest patient died. Mona Ninnes*.

Mona was not only the first to be my patient, but also literally my oldest at 101. She went from driving to my office to needing house calls as she became house-bound and then bed-bound. She was among the first women meteorologists in Canada. I still remember her stories of being a woman working through World War II. Of being told that she would be infertile — and then having her “miracle baby.” Of being brave enough to enter a scientific trial for her severe asthma — and getting better. Of gifting her body to science because much as in life, her death will continue to give back knowledge to others.

I still remember the day she told me she no longer wanted life-prolonging medications. I remember the surprise. Then, acceptance. She was right — this was the best for her. She knew exactly what was coming. We spoke of it at length. And sensing my nervousness, the anxieties of a young doctor, Mona held my hand through it.

That conversation, that non-algorithmic decision-making, that relationship cannot be emulated by a machine. 

So yes, while much of medicine will change in response to technology, some things will stay exactly the same. 

As a profession thousands of years old, we must own this conversation. We must step up. Learn not just the new language of health care, but of economics, policy and management. We are the medical experts of the system. Building a health care system without the physician voice is like building a kitchen without the chef. 

So how do we preserve the best of medicine, its humanity, while making room for technological evolution?

There will be challenges: some technology, like electronic health records, is already associated with provider burnout; we need to fix that. 24/7 flow of information via texts, email and virtual care will blur boundaries and test work-life balance; we need to watch out for that. Collecting more data on patients runs the risk of drinking from a data firehose; we need meaningful processing and protection of that data. Because at the end of the day, it’s not just about numbers, it’s about living, breathing people. 

There is also opportunity. Technology extends capacity for medicine to care for patients who had no access before. It can bring specialized care closer to home for those who live in rural or remote locations. It creates support for doctors so they are no longer isolated.

Doctor’s Day approaches and I will celebrate all that it means, past, present — and future.

I got into advocacy out of a deep, abiding love for this profession of ours. I’m no longer the firebrand I was three years ago. I’ve grown. Changed. Through all that, my love for the profession remains.

Because, plus ça change, plus c’est même.

*Patient name and picture used with permission.