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Motif
Creation
Physicians make knowledge, not only consume it.
A newly universal expectation: every physician is a creative — explorer and designer — empowered to drive discovery, evaluate and validate new technologies, and convert clinical insight into innovation. As machines take over answering questions, asking them becomes the seminal act.
Where it runs — 17 sections
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.
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.
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.