We Need Creative Approaches for Complex Issues

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Akhilesh_Pathipati_PictureAkhilesh Pathipati is a second-year medical student at the Stanford School of Medicine. He is originally from Sacramento, California, and graduated from Harvard College in 2013. While in medical school, Akhilesh has published articles in the Sacramento Bee and the Stanford Scope Blog. Here, Akhilesh answers questions about what drew him to medicine, his thoughts on creativity in medical school, and what changes he’d like to see in medicine.

  • Tell me about why you became interested in medicine.

Akhilesh: A combination of interests drew me to medicine. I spent some time in a clinic when I was in college and two big things jumped out at me. First, I found it very appealing to be able to work directly with patients on a daily basis, and help solve problems in an immediate and tangible way. Being able to help others is probably the single biggest factor that draws people to med school. But the second thing I realized in the clinic is that medicine involves a lot more than seeing patients and prescribing medications. Providing care requires the interaction of physicians, hospitals, insurers, the government, and many other stakeholders. New research and technology constantly changes the way we can treat patients, while economic considerations inevitably shape health care delivery. Figuring out how to make this ecosystem work is endlessly fascinating and incredibly important, and doctors are involved in every piece of the puzzle. So for me, going into medicine is an opportunity to help patients on an individual basis, as well as a way to understand and improve one of the most fundamental aspects of our society.

  • What in medical school so far has surprised you?

Akhilesh: I was pleasantly surprised by the diversity of interests among my classmates. I’m in a relatively small medical school class (~100 students), and given that we’re all in med school, I expected a certain homogeneity of academic goals. But even in such a small group, my classmates’ professional aspirations range from clinical medicine to research to public policy to health education to health tech, just to name a few. It’s been a phenomenal experience to learn how they plan to apply such different backgrounds and interests to improve health.

  • Do you feel that you have outlets to do creative things outside of coursework?

Akhilesh: Medical students have a lot of creative outlets. And many medical schools not only allow their students to pursue these outlets but actively encourage it. Of course, creativity manifests in different ways for different people. Some people demonstrate creativity through their research, community work, global health endeavors, etc. For others, it takes the form of completely non-medical hobbies like arts or cultural activities.

I’ve had a chance to be creative through a number of avenues. My first year of med school, I worked with several medical and law students to help design a local obesity prevention policy, which was a way to think about issues that never came up in coursework. Being able to work with law students also helped me develop a new perspective on familiar problems. In my second year, I had the chance to participate in a few projects involving the implementation of new technology in a hospital, which involved sitting down and thinking critically about how to make it work. I’ve been able to do some writing as well, which has been a great outlet for me to synthesize and articulate my thoughts on the health care system.

  • Do you think creativity is rewarded inside medicine, whether at the bedside, in management, in research, or in other realms?

The short answer is yes, creativity is rewarded in medicine. There are some nuances to consider though. In some ways, medicine (especially medical training) rewards dogged persistence more than anything else. Students are required to go through years of training, take countless exams, and memorize information that may or may not be useful to them down the road. Even once training is done, practicing medicine involves a substantial amount of bureaucracy and paperwork. I think most people in medicine would agree that there are times when it seems like a frustrating test of endurance rather than a rewarding career. This path and the incentives embedded in it have also given rise to the stereotype of the medical trainee who has a stellar resume and checks the boxes at every step of their training, but lacks genuine intellectual curiosity.

But with all of that said, creativity is still rewarded in medicine and is ultimately necessary to be a good doctor. In a clinical context, many patients present with symptoms that do not meet the textbook definition of any disease, or they may present with symptoms that include features of many different diseases. The doctor must be able to put together a coherent, and often complex, story to come to the correct diagnosis. Once the diagnosis is made, a new challenge arises in putting together an optimal treatment plan, especially for patients who have many conditions occurring together. In research, medical investigators must identify important problems, come up with solutions, and then test those solutions to see if they work – an exercise that requires a lot of creativity. In policy and management, decision makers have to evaluate the many consequences of manipulating the health care system. Creativity comes into play in almost every dimension of medicine.

The takeaway is that the easy answers in medicine have already been proposed, and the simple problems have already been solved. We need creative approaches to handle the complex issues that remain, and the field will reward the people who can come up with them.

  • What would you like to see changed in medicine? Do you think you and your fellow medical students will be working on solutions apart from working as physicians?

Akhilesh: One frustrating feature of medicine and health care more broadly is that change happens very slowly. It makes sense that you wouldn’t want to try untested concepts when they could adversely affect people’s health. But at the same time, it’s difficult to improve the status quo when a system is resistant to modification.

So in a very general sense, I would like to see medicine become more adept at responding to new ideas. Two specific examples come to mind. The first is technology adoption, especially with ideas like telemedicine. Telemedicine refers to the use of communications technology in medicine, which often helps expand access to medical care and can cut costs. Despite success in a research context, its early use was limited by a host of bureaucratic constraints. Fortunately, many physicians and hospitals have come around to the concept and are taking steps to increase its usage.

The second example is the process of medical education. Training is based on the Flexner Report, which reported on the state of medical education and provided recommendations for change over 100 years ago. While it was revolutionary at the time, the way we approach medicine and medical research has changed dramatically since then. The training system would likely benefit from an update as well.

I absolutely believe that my fellow medical students and I will work on addressing these types of issues. Physicians have a background and platform that allows them to promote change and drive broad trends in medicine. Taking care of patients is the primary role of a physician, and finding ways to improve medicine is a part of that responsibility.