Information Technology Could Bolster Diminished Ranks of Physician Scientists
Information technology may help save an endangered breed of academic researcher--the physician scientist--who is imperiled by enormous debts and lack of institutional support, says Jeffrey Leiden, Elkan R. Blout Professor of Biological Sciences in the Center for the Prevention of Cardiovascular Disease. He delivered this message at the 2000 Joint Meeting of the American Society for Clinical Investigation (ASCI) and the Association of American Physicians on May 6 in Baltimore, MD.
Leiden's address, entitled "From Genes to Screens, Crossing the Digital-Medical Divide: Can Information Technology Help Save the Physician Scientist?", was his last as president of ASCI, which consists of more than 2,500 physician scientists under the age of 45 and from all medical specialties.
Physician scientists earn both MD and PhD degrees.
"Over
the last several years, we have all heard more and more frequently, 'Physician
scientists, heal thyselves,'" said Leiden in his address. One possible
cure that has been largely overlooked, he said, is the role of information
technology in revolutionizing biological sciences, delivering patient
care, and teaching students.
"Physician scientists have almost ignored the parallel revolution in information technology that has taken place around us during the last 20 years," he continued. "As a result, we are currently at serious risk for hindering future progress in genetic medicine and biology. We are providing sub-optimal and economically inefficient care for many of our patients, and we have failed to evolve innovative teaching tools for our students."
As part of the embrace of information technology, Leiden envisions a national system of medical record keeping in which researchers, physicians, and patients can access centralized files to save time, money, and possibly lives. The system would help cut down on medical errors, he said, because physicians could peruse medical histories easily without wasting precious time tracking down records from other institutions. Take for example, he said, a situation last year at a Chicago hospital where Leiden was an attending physician.
A patient was admitted with chest pain after having been tested for the same problem at another hospital days before. It took 24 hours for the residents to receive the patient's medical records from the other hospital.
"This patient had to endure a hospital stay and multiple redundant tests at a cost of almost $10,000 simply because we have no national system of medical record keeping," said Leiden in his address. He cited a recent report from the Institute of Medicine that estimated preventable health care errors in the US cost between $17 and $29 billion annually. Some of the most frequent mistakes are incorrect dosages or bad combinations of medications. That kind of data can be tracked by rudimentary computer systems, he said.
"We have to find a government agency that will see a national system of medical record keeping as part of its mandate and then convince it that this is something it should spend its money on," said Leiden in a follow-up interview. "That means it must save money in the long run. The hook is the medical errors issue. One can make a compelling argument that an investment of a few hundred million dollars could save billions. That's in everybody's interest."
The same system of medical records could be tapped by researchers looking for health trends and by patients themselves, but Leiden acknowledges the issue of keeping records private must be addressed. He cites Denmark as an example of a country that has kept national medical records for 50 years without a serious breach of confidentiality. He said that determining who has access to exactly what kind of information is one of the biggest questions that faces such a centralized system of record keeping.
"The point is we should be debating this publicly, and we don't," said Leiden.
Perhaps the lack of debate has resulted in part from a lack of voice among young physician scientists. "It is a tough time for young physician scientists," said Leiden. "A variety of forces have conspired against them."
Because they earn two degrees, physician scientists largely face heavier debts, longer training, and fewer immediate financial rewards than their counterparts who choose one degree over the other.
The field has also suffered from financial blows to academic medical centers, which saw reimbursements for medical services shrink as a result of the Balanced Budget Act of 1997. Department chairs were no longer interested in funding research, said Leiden.
"Research was just another money-loser," he said. "Not only was there perceived pressure from the outside for these young folks, but there also was discouragement from the inside."
The result is a lost generation of physician investigators and a larger question of, "Who cares?"
"One of the key questions we have not been addressing is, 'So what if we don't have MD investigators?'" said Leiden. "We'll have PhD investigators, and they're just as good if not better, right?"
It's not that simple, he said. Physician researchers bring a broader knowledge base to science that proves especially useful when conducting projects such as clinical trials in which humans and disease targets are involved. They also are well-versed in organismal biology, which teaches them about biomechanics, developmental biology, ecological and molecular physiology, functional and evolutionary morphology, neurobiology, and paleobiology.
"If you lose the MD investigator, you lose a broad vision," said Leiden.
He hopes information technology will spark interest in potential MD
investigators by expanding the possibilities of their reach and research.
