Physician identity

The Technoscientific Physician

Fluency at the scientific and technological frontier, melded to a drive to discover.

Works at points of convergence where instrument and question are co-instantiated, and where those meet the patient. Runs along two lines — the explorer, who sees that a method built for one problem answers another, and the designer, who notices an arrangement everyone had stopped seeing. Requires interactional fluency and the authority to evaluate, validate, and implement new clinical technologies.

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Where it runs — 33 sections

I. Introduction

Futurism in Biomedicine: The Mosaic MetaphorChange of this kind does not arrive as a revolution, with the world one way in one moment and another way the next. Nor does it arrive as an evolution, through intermediate states that emerge in stages and leave ample time to react.
Arc of Medicine: Historical ThreadsThe first traces the ebb and flow of medical schools. The second follows the regulatory sphere of organized medicine, its boards, its societies, and its licensing structures. The third recounts the history of teaching hospitals and residencies.
Physicians Evolving: Hippocrates 1.0 – 4.0Medicine has reorganized itself perhaps three times in its recorded history, and we are now inside a fourth.
The Hippocrates 4.0 Physician: Plural and Fluid IdentitiesThe overarching view of the future physician advanced here is one of diversified identities and roles.
The Attitude of This ReportFirst, this report approaches the question of the future physician from an entirely different plane. It does not ask which tasks will survive automation, nor how to defend existing scope.

II. The Biomedical Frontier

New BiologiesTwo things are happening at once in the life sciences, and they compound each other: a deepening of mechanism, as our grasp of how living systems work resolves at ever finer spatiotemporal scale, and a dramatic extension of technical power.
Theranostics: Near-Term to VisionaryAs the space of potential theranostics vastly expands, the clinical translational gap widens even faster. The physician should be positioned to help fill that gap, which requires fluency in what is coming.
Editing Germline, Deciphering Brain, Extending Lifespan, Conquering SpaceFour frontier ambitions warrant separate treatment. Each is transformative, and each is double-edged in a way the others are not.
The Discovery Process: AI as Investigative ToolWhat is being discovered is changing. How biomedical discovery is itself instantiated is changing faster, and the second of the two is the more consequential.
The Translational GapTranslational gaps are one of the great opportunities of the coming decades, and one of the places where the physician's absence costs most.

III. Emerging Modes of Medicine

A Matrix of Healthcare ParadigmsAs healthcare faces disruptive transformation on multiple fronts at once, the most useful vantage point is a matrix of interlaced modes of medicine rather than a single trend line.
Machine Intelligence Reframes the Medical Landscape: Blind-Spot Free CareAmong all the disruptors, machine intelligence is the decisive one, not because it is the most dramatic but because it reaches into every other mode. Chapter II treated it as an instrument of discovery. Here it enters the clinic, and the question changes.
Learning Health SystemsIf the modes of medicine are multiplying, something must keep rewriting them, and that something is the learning health system.

IV. Visioning a Technoscientific-Advanced, Data-Rich Ecosystem

Technoscientific Disruption: Multilevel, MultimodalTwo distinct waves of technoscience are reshaping medicine, and conflating them obscures both.
Complexity Science Comes to the ForeComplexity science is the study of systems whose collective behavior emerges from the interactions of their parts and cannot be predicted from those parts in isolation.
AI Intelligence Ecosystem: From Data Procurement to Data CurationThe most consequential misconception about AI in medicine is that there is a single thing called AI. By 2050 the physician's competence will rest on understanding that there is not, and on knowing where each kind of intelligence ends.
Physical AI: A Gradient of AutonomyRobotics follows the same logic of bounded competence that governs AI, and a gradient locates the physician within it.
Statistics, Mathematics and Physics Transform BiomedicineBig data in biomedicine is driving a return of mathematics to the center of medicine, and with it the emergence of computational medicine as a discipline in its own right.

V. Personalizing and Integrating Medicine

Pursuit of N-of-1 Medicine: Humans Fill the Irreducible GapFor most of medical history the central challenge has been too little actionable information about the patient. Within the next decade it may be too much.
Biomedical Digital TwinsThe most concrete instrument yet devised for closing distance to the individual is the digital twin.
From Repair to Preemptive MedicinePersonalization changes the timing of care as well as its precision.
On the Road to Holistic/Integrative MedicineN-of-1 reasoning widens naturally into holistic medicine, a term that should be rescued from its history.
Rethinking the Evidence in Evidence-BasedEvidence-based medicine is conventionally defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients, integrating individual clinical expertise with the best available external evidence and the patient's values.
The Patient of 2050A report that redefines the physician owes an account of the patient, and this one has so far described the patient chiefly as a biological particular: a genome, an exposome, a stream of measurements, a twin. That is one kind of particularity.

VI. New Modes of Physicianship: A Collective of Experts

Intelligences Meet: The Human AdvantageEven if AI superintelligence is achieved, a compelling human niche will persist.
Recasting Physicians in the Age of Machine Intelligence: Guardian of HealthRelating the human advantage to the biomedical sphere requires a frame, and the most useful is the meme of the physician as Guardian of Health.
Four Physician Identities: Contours of the Hippocrates 4.0 PhysicianIn recasting the physician as guardian of health and as a member of a collective of experts, both claims concern standing: what the physician is for, and who answers for what.

VII. The Technoscientific Physician

The Physician Creative: Explorer and DesignerIn 1910, Abraham Flexner reframed the physician as a practitioner of scientific medicine.
Reimagining the Biomedical Research EnterpriseExhorting physicians to be creative while leaving the surrounding enterprise unchanged is a recipe for individual frustration. The structures must change too.
The Curious Physician: Nurturing WonderThe explorer and the designer both rest on something prior to method and prior to infrastructure. An explorer must first find something worth exploring, and a designer must first notice that a thing is badly made.

XI. Minting the Hippocrates 4.0 Physician

Hardwiring the Mid-21st Century Physician: The Future CurriculumThis report has considered throughout about what medicine is becoming, and it now turns to what must therefore be taught. A view of the evolving modes of medicine, and of the physician who will practice them, is a specification for training.
The Simulation FrontierIf mentoring is the highest-yield structural change available to medical education, simulation is the highest-yield methodological one, and medical education currently uses it at a fraction of its capability.
Revisiting Lifelong Learning: The Adaptable PhysicianThe century-old sequence of medical school, then residency and fellowship, then episodic continuing education is no longer the right structure for a forty-year or more career in a changing technoscience realm. The continuum should be reconfigured in several specific ways.