From 'god-like' to team huddle: Training doctors for a new health care future

Thomas Eakins' "The Agnew Clinic," displayed at the University of Pennsylvania medical school.

Later today, 33,000 aspiring doctors will find out where they’ll be doing their residencies for the next three to seven years. In medical circles, they call it "Match Day."

In the last few years, doctors and hospitals have begun adapting the on-the-job training residents receive, so they can better succeed in today’s tumultuous health care world. But the past is never far from view.

At the University of Pennsylvania medical school, historic paintings of doctors and professors line the marble hallway in one of the oldest buildings on campus.

Dr. Bill Hanson, who helps oversee resident training at Penn, describes one of the most famous paintings, “The Agnew Clinic,” by Thomas Eakins in 1889.

“That’s Doctor Agnew there, pontificating in front of an auditorium full of amazed medical students,” he says.

Hanson says the painting embodies the god-like position doctors held for more than a century.

“The central figure in medical care is that isolated one professorial figure in white. And everyone else around him is in shadow, or secondary to that fount of wisdom. Very, very different from what we are talking about today,” says Hanson.

The picture of today’s doctor? The team huddle.

Dr. Brian Smith, who’s wrapping up his training at Penn, makes rounds with an assorted crew of nurses, students, and residents. Smith says teamwork is critical in the new health care era, for improving patient health, avoiding errors and holding down costs.

“We’ll say, you know, does anybody have any other ideas, are there any concerns that we are not addressing. And a lot of times that evolves into a dialogue,” he says.

Dr. Bob Wachter at the University of California, San Francisco says doctors can no longer just take care of sick people.

“I like to say that the doctor of the future has two sick patients. One is the patient they are taking care of. One is the system they are working in,” says Wachter.

So while residents at UCSF still pore over case studies -- like they have for generations -- they’re also getting a lesson in economics.

“They get that if they are doing CAT scans when they shouldn’t be, not only are we bankrupting companies and the government, we are bankrupting people,” he says.

Wachter says now, it’s an obligation to teach residents the business side of the profession. Because while the days of the god-like doctor have ended, physicians are still the central figures in medicine.

And Wachter says it’s up to this the new crop of doctors to treat what ails the health care system.

About the author

Dan Gorenstein is the senior reporter for Marketplace’s Health Desk. You can follow him on Twitter @dmgorenstein.

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