I grew up with a story about an intrepid pilot during World War II who was summoned to his commanding officer who was looking for a range of perspectives on innovation and aviation. His first question was rather easy. “In the future, will our current planes ever go faster than their current speeds?”
The answer, at least the expectation of the commanding officer, was fairly simple, if not obvious. And a good ice-breaker to start the discussion. But the young pilot’s response caught his CO completely off guard. The pilot reacted, as pilots often do, with a simple and emphatic word: no. At that moment, the tone of the conversation changed rather dramatically, and the officer looked quizzically at his inexperienced student and asked why. His answer was both factual and based on science versus speculation or military optimism. “With our current engine specifications of lift and drag, higher speeds would require the engines to be too big. And, at that size, the resulting aerodynamics would not allow a significant increase in airspeed.” Of course, the answer didn’t incorporate the jet engine which was the real game-changer and not yet available to either the military or commercial aviation. But that innovation was just around the corner.
Years later, a young medical student was called into his attending’s office. This time, the discussion was regarding his application for a residency program at a prestigious medical center. The conversation followed a similar path as the young pilot, as they both chatted about the evolution and transformation of medicine today and into the future. The discussion turned from the clinical to the philosophical, as the student spoke of his father’s dissatisfaction with his current job as a primary care physician. The future seemed a bit uncertain for both father and son.
Then the question from the attending came. “Do you feel that the physician of today, you and me, will become obsolete?”
The medical student was on guard, as this was an important interview. So, it’s no surprise that he heard zebra hoofbeats in the distance. But still his response was swift, resolute, and almost pilot-like—he said yes. But there was more to come. He spoke eloquently of his father and how the joy of medical practice had deteriorated into a system where pre-authorization became a misplaced journey of hope for both the clinician and patient. He explained how holding a hand was replaced by holding a mouse and peering at a keyboard and screen. And he opined on how his father would come home late at night, exhausted and burned out from a system that seemed to priortize dollars over heartbeats.
His point was clear. That physician of today is obsolete. The role is inconsistent with the human needs and desires expressed by patients, caregivers, clinicians and all those who provide that simple four-letter word: care. But he continued about his personal expectations for tomorrow. He clearly didn’t want to become that type of physician and suffer the consequences of an oppressive system. It had little place for him or his father.
His voice became elevated and optimistic as he presented his generation’s future and reclaiming the joy of medicine. His vision wasn’t a compromise, but a perspective on how technology can redefine roles, share the cognitive burden, and even enhance his human capabilities such as hearing, touch, and sight.
Just like the jet engine, advances in technology that he grew up with, can help define his humanity and redefine medical practice. He tempered his perspective with the reality that this is no simple task or path. And in many instances, it’s already been declared DOA by those types who still flew in the old “prop jobs” of yesterday. He concluded with the simple observation that change, and change for the better, is at hand. And his job, as a new intern, would certainly be to hold the hand of his patient. But sometimes, he concluded, technology might be holding his other hand.
Author’s note: The young pilot in this story is my father, John T. Nosta who was a Naval Aviator in World War II. He later went on to become a successful electrical engineer. His vision was both practical and forward-thinking. And sometimes, he liked to fly very fast. The year 2022 is the 100th anniversary of his birth.