As the health care environment continues to change with new payment and delivery models and technological advances like big data and artificial intelligence, the role for the individual physician is also shifting. During yesterday’s James T. Dove Keynote, John E. Brush, MD, FACC, discussed these topics and explained the role of cardiologists in a shifting health care landscape that is focused on measuring outcomes and value.

According to Brush, for some cardiologists, the increased focus on outcomes, productivity, technology and evolving roles on the health care team has led to a loss of professional identity and has contributed to the epidemic of physician burnout. Nearly 50 percent of physicians have reported symptoms of burnout, according to the National Academy of Medicine.

“It’s no wonder that we’re burning out,” Brush said, noting that electronic health records and reimbursement formulas have made it more difficult to focus on patients. “Even the quality movement has been distorted and has turned us into automatons, procedures have turned us into proceduralists, payers have turned us into commodities. The push for productivity values speed over quality, leaving little room for reflection and study.”

"Our actions have profound consequences so it’s important to think hard about the knowledge and thinking that drives our actions ... Thinking then doing is the optimal way to put our specialized knowledge to good use." — John E. Brush, MD, FACC

Despite these significant changes, Brush said the future remains bright for physicians if they stay focused on their specialized knowledge and the process of medical reasoning. “We’ve forgotten that the thing that distinguishes us as physicians, as cardiologists, is our knowledge. We have the abstract knowledge from book learning, but also experiential knowledge, which enables us to use intuition to solve clinical problems and make judgements about patients. That’s the essence of medical reasoning,” he said.

According to Brush, understanding the process of medical reasoning, or the cognitive process of making a diagnosis, will guide physicians to make better medical decisions, and in turn drive quality improvement. Brush walked the audience through medical reasoning, explaining that cardiologists’ specialized knowledge enables them to think through clinical problems. “Our actions have profound consequences so it’s important to think hard about the knowledge and thinking that drives our actions. There’s a clear order of operations. Thinking then doing is the optimal way to put our specialized knowledge to good use.”

While technology will continue to advance, and clinicians will need to adapt to new payment and delivery models, the individual cardiologist will remain relevant, Brush said. Rather than look at new tools like artificial intelligence as a replacement for medical knowledge, he urged attendees to use them to enhance decision-making. “Artificial intelligence augments our intelligence, but at the end of the day it’s the human decision where you infuse human values, empathy, caring and values that can’t be programmed into a computer.”

Brush called on the audience to rebuild their professional identity by remembering their sense of purpose after medical training. “Our knowledge is what makes us who we are. We need to respect our own knowledge, wisdom, education and thinking.”

Keywords: ACC Publications, ACC Scientific Session Newspaper, ACC Annual Scientific Session

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