From Your Health, Your Decisions: How to Work with Your Doctor to Become a Knowledge-Powered Patient. Copyright © 2016 by Robert Alan McNutt, M.D. Used by permission of the University of North Carolina Press. www.uncpress.org
My name is Robert McNutt. I graduated from Michigan State University (MSU) in 1971 and studied philosophy and the humanities. My plan was to be a high school teacher and swimming coach. But, as a wise saying reminds, life is what happens while making plans. So, while on the trail to becoming a teacher, I decided to apply to medical school. Applying required me to test my ability to intellectually survive training in medicine. The medical school application test and I did not get along well; my score was low as there were few questions on the test about philosophy. Despite the score, however, I was granted an interview for admission.
The interviewing professor, a psychiatrist, held two pieces of paper, one in each hand, and he glanced at each paper in a back and forth manner. After a moment, he asked me how my grades in the humanities (Phi Beta Kappa level) could be reconciled with what, he said, was a low medical school admission score? Our ensuing discussion lasted over an hour. I said that the test did not ask questions I expected based on my understanding of what it meant to be a physician. My understanding derived from experiences in my home. I said that my grandparents and uncles died in our home with my family caring for them. I told him how important a doctor was to our family and how much we appreciated help when we were ill, and, also, how much we appreciated kindness at the limits of expertise. I told him I still remembered a physician’s visit to our home for my ill sister, and that my Dad and the physician shared whisky after the work was done. I told the professor that I wanted to go into medicine to share a metaphoric (perhaps, occasionally, literal) whisky with each person I would be privileged to care with.
Apparently, the professor liked whisky. I got in to MSU medical school, and, thankfully, the medical admission test score did not predict my success. After graduating in 1975, I did my internship in general/family medicine, worked in an emergency room in rural Michigan, returned for Internal Medicine training, and, finally, training in Oncology. After fellowship, I practiced in a solo Oncology, and, later, a 2-person Oncology practice.
During my private practice years, I saw medicine’s goals and actions drastically change. Information was being produced in vast quantities; patients were being reassigned diagnostic labels; treatments were propagating. I saw the rise of uncertainty in benefits and harms inherent in our burgeoning newly added tests and treatments. I read studies in cancer care showing advances, but the advances did not seem to extend to my, or my colleagues’ patients. I watched the medical system embrace technology at the expense of philosophy. I saw patients packaged to an average rather than being valued as individuals. As a result of my observations, I decided to learn the methods of science to better answer questions posed by my patients, and to reconcile discrepancies between what I read versus observed while caring for patients.
So, I went back to school in a National Library of Medicine Fellowship at Tuft’s New England Medical Center, and attended classes to learn epidemiology, statistics, and decision-analysis. After 3 years of additional training in this fellowship, I returned to practice as an academic physician. The University of North Carolina, The University of Wisconsin, Cook County Hospital of Chicago, and Rush University Medical Center have been my academic homes.
During the academic years I experienced nearly every medical task; clinician; researcher obtaining grant funds from many agencies including the National Institutes of Health (NIH); I wrote over 200 papers and abstracts and presented my research at national meetings; I ran a medicine clinic; I became a medical director of a health maintenance organization (HMO); I became a Chairman of Medicine; a director of a Health Services Research unit; a director of research at a safety-net hospital; and a director of a program in patient safety research. I was a member of national committees, ran national programs for the Society of Medical Decision making, and reviewed other researchers work at the NIH and the Veteran’s Administration (VA). I was interviewed to be on the Center for Medicare and Medicaid Services (CMS) Governing board; I became an associate editor at three journals including the Journal of the American Medical Association (JAMA).
Being an editor and researcher has allowed me to see/conduct nearly every type of study on numerous topics in medicine and I have learned how information can mislead to the ultimate detriment of a patient’s care. I also noticed, as mentioned above, that, philosophically, the medical system was abdicating its responsibility to individuals in order to support a science of populations. But, populations only get better by improving the care for individuals. Unfortunately, in my view, medical leaders have become too interested in the medical system for its own sake, and the way we conduct science presently, even, supports systems rather than individual patients. Science will be better when it is conducted in such a way that it supports an individual’s right to participate in his/her own medical care. Presently, medical care is a top-down industry (medical business on the top directing decisions down to patients). We must reorient to a patient on the top profession. A profession of medicine will emerge only if it aligns exclusively with patients’ rights and abilities to fully contribute to their care.
And, my experiences tell me it is vital for you to now fully participate in care. The production of good and bad information is escalating. Learning what information is reliable, and, then, learning how to use reliable information to enhance your medical choices will be an indispensable future skill. However, if you are to fully contribute to your medical-decisions you must be trained in medical-decision-making. Wanting you involved in care is not enough. After all, it is difficult to catch fish without a pole. Rest assured, though, making your own medical choices is a skill that can be learned.