Physician identity

The Transcendent Physician

Medical virtue, meaning-making, moral agency, and judgment at the edge of the unprecedented.

Speaks directly to the irreducible human advantages. As machines absorb the routine cognitive and technical core, the profession's center of gravity shifts to what a machine can simulate but not genuinely possess: caring as the physician·patient I-Thou, ethical judgment, wisdom, and presence at the encounters reserved for human beings by policy rather than preference.

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Where it runs — 22 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.

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.

IX. The Transcendent Physician

The Human FactorThe phrase transcendent physician conveys the dimensions of the future physician that transcend those of advanced technologies and machines.
Rehumanizing Medicine: Medical VirtueThe differentiating human qualities go deep, and they encompass far more than the oft-repeated empathy. Here we resurrect two terms: ‘rehumanization and medical virtue to convey the broader set. The question is what the prefix in rehumanizing is doing.
Complexity, Data, and the Limits of PredictionThe nexus of complexity science and biomedicine is a rich conceptual space with almost endless possibility, and working seriously inside it, the physician adopts newly configured roles, as a decipherer, navigator, and engineer of complex adaptive systems.
Judgment and Wisdom: Ethical Decision-Making, Evaluating TruthAs machines absorb diagnosis and documentation, value concentrates at the edge of judgment.
The Problem Solver: Educating to Critical ThinkingJudgment concentrates where the model runs out, ethical reasoning is the connective tissue binding the whole of the human advantage, and evaluating truth is a discipline of intellectual honesty more than a technique.

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.