Definition is everything

This entry is part 1 of 1 in the series Defining a doctor
  • Definition is everything

Claire McCarthy, who according to Sharecare is currently the top online influencer for children’s health is not just an advocate for getting doctors online and getting doctor-patient collaboration fired up online, she is an advocate for changing how we think about things.  Even how we think about the entire definition of medical practice.

The article here culminates with a great line:

“It means thinking outside the box; it means redefining medical practice as existing beyond the exam room space.”

Yes, she says (quickly…) “its never a good idea to make a diagnosis online” (referring as much to patients googling their symptoms as to doctors and patients communicating remotely.  Yes, she says, we need to think of the online space as an “extension of the in-person health care, not a replacement” of it.  But, conditional statements dealt with, she talks of the “incredible potential and possibilities that exist…”

It is interesting that she understands the need to throw in those two big conditional statements, one about diagnosis and one about “replacing” face to face consultations.  They are the two almost irrational fears of the profession, “OMG” you can hear doctors say “you can’t diagnose over the phone or online!”  And the worry about family doctors losing their business because online mega e-clinics steal their patients away?  Well I don’t think I need to address that do I?

The need to address the fears talks to a core “theory in use” underlying the discussion.  People are seeing remote consulting one way, which means they are seeing consulting one way.  Which really means they are “seeing” the role of the doctor one way.

And then it is interesting that Dr McCarthy uses that significant sentence “it means thinking outside the box; it means redefining medical practice as existing beyond the exam room space.”  She rightly lasers in on the real issue here – how do we see the practice of medicine?  What is it??

Logically if we see it as only existing in the “exam room space”, then online activities and telemedicine and video consults and emails and texts and real time chats are NOT the practice of medicine.  By definition.

But tell me honestly you know a doctor who has never, ever, ever spoken to a patient on the phone?  Or received to or replied to an email about a patient’s medical results or symptoms?  Or that you know a doctor who never goes online, never talks to patients about online information and resources?  One that never texts and never reads texts from patients or other practitioners about patients?  Ever???

It is patently obvious that doctors engage in all of those, probably every day.  So what are those activities if they are not the practice of medicine?

And we know intuitively or through personal experience that much value can come from interactions with our doctor outside the “exam room space.”  We know it works and helps us out.  It is by any reasonable measure still the practice of healthcare.

So then what the heck is healthcare?   How can we think out of the box, how can we define it?

A more important thought is this:

“If we did define the practice of medicine differently, would we think differently about “newer” modes of interaction like telemedicine, emails and virtual consults?”

The answer has to be yes, which means this must be where we need urgent focus.  Looking at the role of the doctor differently means looking at everything differently.  In future articles in this series I want to explore in more depth what the prevailing definition of medical practice actually is and offer an alternative viewpoint which suddenly makes forms of interaction with a doctor outside the “exam room space” make a lot more sense.  Yes, we might define around a doctor, which is worth looking at itself, but the doctor role is really the archetypical role for any therapeutic relationship between a healthcare professional and a patient.

Definitions are not just definitions – they are “mental models”, the theories we use to give meaning to things in the world.  They are how we see and judge everything.

They are everything.