Sunday, February 22, 2015

Dr. Topol's bad day

Dr. Eric Topol is a cardiologist, author, editor-in-chief of Medscape, and genomics professor. In 2009, he was named one of the 12 Rock Stars of Science by none other than GQ magazine.

But even rock stars occasionally have a bad day. After blogging for almost 5 years, I sometimes have trouble thinking of things to write about. This apparently happened to Dr. Topol the other day. He published a Medscape article with an accompanying video about how doctors are being squeezed by many outside forces that require them to do things they don't want to do.

It was kind of a rambling discourse in which he suggested that doctors should offload the responsibility to do these "more mundane aspects of care" to the patients. He thinks this would make medicine more exciting "the way it used to be."

Dr. Topol offered this cartoon to illustrate the outside forces that are squeezing doctors.

Genomics is a focus of Dr. Topol's research, but I don't think a lot of doctors are concerned that they lack knowledge about it.

His post created a lot of controversy prompting Medscape to take down all of the comments.

With great foresight, one physician, Dr. Kristin Held, preserved her comment with a screenshot which I have thoughtfully provided for you below.

What do you think she really wanted to say with the start of her second paragraph? Could it have been "How about growing a _ _ _ _ of _ _ _ _s?

Like Dr. Held, I have no idea which of the "mundane aspects of this new world" Dr. Topol had in mind to offload on the patients. Of the 16 forces squeezing doctors that he illustrated, I don't see many of them being taken over by patients. They already control patient satisfaction and what's written on Yelp. Maybe they can cover the lack of genomic knowledge too.

It's sad that an influential doctor like Topol is so lost in the woods. However, the bright side is that gave me something to write about.


Carolyn Thomas said...

I'm going to get right on this... I'm going to take on the responsibility for some of those "more mundane" tasks that important doctors like Dr. Eric simply "do not want to do" anymore.

Think I'll start with Algorithms and Retail-Based Clinics and then maybe EHR Frustrations because those are issues I'm eminently qualified to take over entirely for him and others of his ilk.

And really, why should these mundane burdens be born by such a bona fide "Rock Star of Science"?

I'm glad that at least one sharp commenter, Dr. Kristin Held, preserved at least one of the comments for us. It's unfortunate ( and so gutless!) that Medscape chose to take down only the comments, instead of the entire post.

Skeptical Scalpel said...

I am surprised you didn't want to tackle lack of genomic knowledge. :-)

Moose said...


I strongly suspect that Dr Held said what she wanted to say. The implication of the phrase "grow a pair of balls" (there, I said it) is that you have to be a MAN, and a TOUGH MAN, to do [whatever].

It's right up there with the idea that to be weak is to "do [whatever] like a girl."

People of all genders have spines. However, some of us seem to forget they exist. Sexism hurts both ways. Don't let there be stereotypes for women OR men.

Carolyn Thomas said...

Well, that was next on my list of course....

Anonymous said...

I'm glad you posted this AFTER I went to church.

That being said, I would have loved to see the other comments. Since Dr. Held emailed you, could you please send her a note telling her (or ask her to come here if you approve my comment), that I haven't cheered at a blog post like this in a while. Thank you for the laughter and the cheering.

I needed it.

Narayanachar S. Murali, MD, FACP, FACG said...

What is wrong with what he said. He was just weary fighting against the war on doctors. Perhaps he realized a bit late that the mundane forces against doctors are so strong they have even awakened translational scientists and Genomic professors.
Perhaps he was secretly expressing a hope that if these mandates that are sold as quality junk to us( through advertising and patient pressure) is offloaded to consumer who pays for it , they may see some reason to free us from our own fetters.
I wish he had left the article as it is and defended himself in a more articulate manner. He is a good debater!
He has done a lot of good for us including supporting NBPAS. I hope they don't harm that mission in similar light.

WakingUpCosts said...

Here's favorite way to visualize these outside pressures:

frankbill said...

Some might want to do a search for Dr. Eric Topol.

frankbill said...

As a non medical person I see two things that if were changed would go a long way in helping with the problems.

Patient satisfaction needs to very close to top of the list. True you are not going to be able to satisfy every one. Nor are you going to have all the answers. But having someone that remains un Dx for years and all you do is after a few tests tell them it is all in there head only makes for a very unsatisfied patient. I believe as long as you keep on open mind and keep trying to help your patients this will help keep them satisfied.

Of course this cost money to do and not likely that insurance is going to keep paying. So reimbursement now becomes the problem. At least for now doesn't look like there is a good fix for this.

Unless Drs can change how they get paid they are forced to choose between providing needed care or getting paid.

Skeptical Scalpel said...

Anon, Dr. Held didn't email me. Her comment was tweeted by someone I follow.

Dr. Murali, you may be right but he certainly did not articulate it the way you hope.

frankbill said...

You can watch a video of Dr Eric Topol on Doctors Are Getting Squeezed. here.

Skeptical Scalpel said...

Frank, thanks for the tip, but there's a link to that video in the second paragraph of my post above. Click on the word "article'" and you will arrive at the same link.

William Reichert said...

I think Dr. Topol implied he was referring to the things associated with the fact that he thinks patients are interested in" managing their data". I see that there are a lot of tools out there that can record your pulse and BP continuously.Probably record every calorie you eat. Your 24 hour glucose. How many "steps" you take each day .Maybe your oxygen saturation at night along with observing for episodes of sleep apnea . So it will be simple.Medicine IS simple . It is, after all "evidence based". I suggest we ask the patients to monitor and collect all their personal data. Then enter their symptoms and their genome into a computer. Then enter their physical exam results performed by the local Wall Mart nurse practitioner. The computer will tell them what tests they can order. The results will be sent back to them for review. We can give them a free subscription to Up to Date .com. They can review it and decide what they want to do. They then enter their treatment plan into a computer .This computer is connected to the Institute of Medicine. The I of M will look at the treatment plan and the data and if approved will send a Rx to the patient's drug store of choice., hopefully Wall Mart.,a preferred provider. Patients will absolutely love this. This will save billions of dollars.Doctors will no longer be needed at all. .What could possibly go wrong?

frankbill said...

If one watches the video you get a better understanding of what he is trying to do. It is wasn't for the cartoon more would agreed with what he said.

Here is an other link that should be of interest.

Skeptical Scalpel said...

William, what could go wrong. I don't know what types of patients Dr. Topol sees, but people that I took care of were not about to monitor their own data. These guys who write this stuff ought to see what live is like in the real world.

artiger said...

True, Scalpel. If you live in a rural and/or economically depressed area, you're dealing with a population that might try, but really can't comprehend about half of what you try to explain to them.

Off topic, and not to derail this post, did you notice this article on Medscape?

Might make for an interesting discussion.

Skeptical Scalpel said...

Artiger, I'm glad you agree with me. That paper about feeding patients was interesting but very small numbers. Previous papers have shown that solid food of any kind is better than clear liquids.

Libby said...

As a patient I was going to take genomics but while looking up what it was I dozed off. I also not sure what impact me knowing that stuff would have on my concussions (linking my dumb moves to the suspicious deaths (murder/suicide?) of my Irish-Catholic immigrant great-grandparents during the influenza epidemic in 1917?).

I agree with Dr. Held, if you don't see the relevance, grow a spine & just say no (a new version of the "Just Say No" campaign).

Frankbill, one of my favourite family doctors had a dx for those elusive ills- he called it "JOOTT", "just one of those things". Sometimes the symptoms are all we can treat ("we" as in the doctor&patient "we").

The best "mundane" thing a patient can do is take care of themselves, in whatever way they need to do it.

Skeptical Scalpel said...

I agree. Patients should take care of themselves. The trouble is, many do not. Topol assumes that patients are eager to assume responsibility for their own care and the BS that docs are being required to do. It ain't gonna happen.

oldfoolrn said...

If someone is really sick, they probably don't have any "mundane" problems. The population I cared for had serious issues and were not in a position to assume care for any issues beyond basic survival. I agree with Dr. Held's eloquent assessment

Skeptical Scalpel said...

Old, I agree. Even if they wanted to (and I doubt many do), they would probably not take over the mundane tasks.

frankbill said...

Skeptical you should read oldfoolrn bolg

Oldfool if things were still the same as when you were working then would be less need for the sick to do mundane tasks.

William Reichert said...

There is a new slant on patients taking care of themselves.
According to the latest take on etiology of disease, recently described on news radio, almost all chronic disease (diabetes, HPB, cancer,heart disease, depression,etc) and almost all things we traditionally think of as contributing to these diseases ( smoking ,obesity, bad diet, alcohol abuse) are caused by something now
called Abusive Childhood Experience. This is now proposed to be the
common determinant of almost all adult diseases. You can google "ACE Score" and a wealth of information will be revealed. To me, this is discouraging since to my knowledge there is no way to erase ACE or for that matter prevent it.. Any way if this is so, asking the patient to take responsibility for her health seems futile. It is all predetermined during childhood. Fascinating.

Skeptical Scalpel said...

William, I've been reading about ACE scores. Thanks for the tip. It might be a good blog topic.

Frank, I did. Interesting.

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