Chapter VIII
The Consilient Physician
Breakthroughs increasingly occur where disciplines meet. Yet the structures meant to enable that work obstruct it, and the singular physician is meanwhile dissolving into a distributed intelligence.
Recommendation
Recommendation. Cultivate consilience as a core physician competency rather than leaving it to chance. Restructure specialties deliberately, beginning with overlay specialties focused at first on cross-cutting knowledge domains at the technoscientific frontier, with boundary redrawing on a slower parallel track. Systematically enhance the distributed intelligence of horizontal care teams, factoring in the expanding scope of practice of other health professions. Elevate interprofessional education from supplementary enrichment to core curricular component. Abandon error-catching as the case for physician oversight, and instead, argue for answerability, as it is both narrower and truer. Place greater emphasis on working prototypes of optimized horizontal care, with rehabilitation, mental health, geriatrics, and chronic disease management among them. Explore affordable care models that optimize patient navigation and better integrate the patient experience across specialties, health professions, and other social sectors.
Sections
- 01Bridging Knowledge Domains: ConsilienceOne tension runs through this chapter: deep knowledge of a single domain against working knowledge of many, the specialist against the generalist. Physicianship has moved decisively toward the specialist.Exhibit 8.11 definition
- 02Counterbalancing Specialty FiefdomsSpecialties are the institutional form that knowledge domains take. A specialty is a boundary drawn around a body of knowledge, staffed, credentialed, reimbursed, and defended, and where those boundaries fall determines which connections are easy and which require crossing a border.Exhibit 8.2
- 03An Embrace of Distributed Intelligence: Horizontal CareThe singular physician dissolves into distributed intelligence.Exhibit 8.3Exhibit 8.41 definition
- 04Interprofessional Education: Reifying ConsilienceThe physician's function within distributed intelligence is to coordinate a widening spectrum of caregivers, partnering rather than directing, within a system whose other participants increasingly include machine intelligence and robotics. Interprofessional education is the road to that destination.Exhibit 8.5