Matt Stammers, Clinician Software Developer, Gastroenterology specialist registrar, healthtech entrepreneur and co-founder of Clinical Developers – an organisation that supports the cross-fertilisation of medicine and computer science – writes about the mental outlook and cutting edge skills it takes to change the face of healthcare. He wants to get you inspired
As Mark Twain once wrote, ‘whenever you find yourself on the side of the majority, it is time to pause and reflect.’ It’s not always good to go with the flow.
And here’s a good example. In 1985, young maverick Australian doctor Barry Marshall drank a broth containing helicobacter bacteria. It was an act of defiance that brought years of condemnation from the establishment. At that time, he had been working on this bacterium for two years following advice he received from a senior histopathologist colleague. Despite many attempts to culture it in animals, he had failed. Their theory was that this bacterium was the cause of stomach ulcers. But, like several others before him, they had been unable to prove it in the lab.
Fortunately, Barry Marshall was not like most other doctors. Out of sheer desperation, he tricked an endoscopy colleague into performing a gastroscopy on him in order to prove he did not have the bacteria. Without ethical approval – and without even informing his wife – he drank the bacterial broth in secret. At the time he thought he would probably develop an ulcer in a year or two. In fact, it only took a few days for him to be admitted to hospital with severe gastritis.
Many others had tried (and failed) to prove that helicobacter was the cause of stomach ulcers. They failed because the medical institution and big pharma at the time had no interest in such a discovery. Such a ‘cure’ would end the need for a whole generation of ‘ulcer surgeons’, and the vast quantities of drugs that treated but didn’t actually cure the disease.
But why did Barry succeed where others failed? Many have asked and attempted to answer this question over the years. Was he smarter than the others? Was he more ambitious? Or foolish? Was he just lucky? The answer isn’t straightforward, and to reduce the answer to just one word would constitute ambitious folly itself. However, I’m convinced that Barry Marshall possessed some key components that none of the others had:
In short, he was completely invested in solving this problem. Unlike all the others who had gone before, Barry Marshall drank his own poison because he was more invested in it, cared more about it, and was totally committed to the project, not himself. In that moment he acted selflessly – something the others couldn’t and wouldn’t countenance.
We see this pattern again and again throughout history. Would Ignaz Semmelweis have discovered the cause of ‘childbed fever’ had he not lost a colleague to sepsis and then chosen to take selfless action? We owe the discovery of modern medical hand hygiene to this selfless Hungarian. Ignaz Semmelweis suffered heavily for his selfless convictions – roundly derided and rejected during his lifetime for his work, he gave us what couldn’t have been discovered in any other way and latterly became known as the ‘saviour of mothers’. Many of us owe our lives to him.
Would John Snow have isolated the Broad Street pump as the cause of cholera had his heart not gone out to the people dying all around him from the disease? This generous man put himself in jeopardy in order to discover the cause of cholera. While all his colleagues were fleeing London he stayed, and because he was so personally invested in the problem he saved many lives, founding the field of modern epidemiology in the process.
So my summoning call to readers is this: become invested in the problems you face daily. And do the work for the sake of the work, not for ambition or any other reason. Take positive action and commit to solving a problem that is meaningful to both yourself and others.
Why don’t more people do this? It’s because there’s a high price to pay. It requires learning new skills to solve problems, plus not buying into the falsehood that only ‘professionals’, big companies or others can solve these problems. The truth is they can’t. Only you can solve the problems you are uniquely positioned to solve, and you might just create a new field of science in the process.
Barry Marshall was just a Gastroenterology registrar (like me) when he made his discovery. It is only now, with hindsight, that he’s recognised as a great example of the ‘clinician scientist’ – a now well-recognised phenomenon. It cost him his reputation – for many years he was rejected and mistreated by colleagues and industry alike. Only in 2005 was he finally awarded a Nobel Prize for his work, and today he is considered a medical hero.
Ignaz Semmelweis, the father of modern hygiene, only became so because he was curious about something he observed. Where many would have let the unexplained death of a colleague go, Semmelweis couldn’t: he was intrigued. Intrigue led to discovery, which led to conviction, which led to commitment in the face of adversity, which ultimately led to breakthrough. He received little glory for his work during his lifetime.
The modern field we now know as Epidemiology did not exist before John Snow. Through his commitment he drew the first epidemiological map and began to turn the tide on cholera. He was one of only very few physicians in London at the time and so one of only very few people who could actually have made the discoveries he did. He worked out where he fit in the world, and he ran with it.
These three heroes share threads of commonality. None of them were entirely alone in their endeavours (even Semmelweis and Snow had communities of support), all of them were ‘square pegs’, all of them were fully committed, all of them had to learn new skills, all of them did the best with what they had, and all of them acted selflessly.
I came up with this name by mistake. I was trying to explain to some colleagues what kind of doctor I wanted to become, and the name popped up. Not that the name is important. Indeed, it may well change. What is important is what it stands for – which is the ‘builder’ clinician. Traditional pathways for clinical staff have generally been: clinician ‘specialist’, ‘generalist’, ‘manager’, ‘teacher’, ‘scientist’ or more recently ‘entrepreneur’. All of these pedigrees (apart from the entrepreneur) have very long histories and the routes to becoming on are well established. However, I’m convinced that the time has now come for a seventh type of clinician – the ‘clinician developer’ or builder.
In a sense all clinical staff are builders – from writing protocols or business plans to conducting research. However, what I’m referring to is a particular kind of clinician who has their feet in two different worlds. They straddle the world of the clinician with all its arcane knowledge and tradition, and the world of the software developer with all its flux and change, constant upgrades and machine intelligence. I believe that the fusion of these two worlds is the future. I believe that both worlds can learn a lot from one another, that they fit together hand in glove.
Medicine has become an increasingly complex domain, so complex in fact that my brain physically aches every day as I try to assimilate and sort vast quantities of information. Humans do not do this very effectively. As Daniel Kahneman points out in 2011’s Thinking Fast and Slow we tend to oscillate between two types of thought – Type 1 (fast, automatic, frequent, emotional, stereotypic, subconscious) and Type 2 (low, effortful, infrequent, logical, calculating, conscious). As healthcare requires much more Type 2 than Type 1, this poses a significant problem for us as clinicians, and sometimes proves dangerous to our patients. We need software solutions that can help ease this Type 2 burden, but so far they don’t exist. In fact, most of the IT solutions we currently have are very good at collecting and presenting vast quantities of information… just not in a way that helps us as humans or healers.
Software developers and data scientists alone cannot help us. Even when a clinician works in close proximity with a developer (a combination that can work) success is not guaranteed. Granted, you can make progress – but this is where I come back to my original point. The issue is one of selfless investment. The software developer or data scientist doesn’t actually have to deal with the problem themselves, so therefore they are not fully invested in it, and they’re probably not acting selflessly.
We easily forget nowadays that these problems are by their very nature extremely difficult to solve and some are effectively intractable. Therefore, it’s only someone who is possessed of several skillsets and is fully selflessly invested in solving the problem that can actually solve it. All the heroes listed above needed to be both deeply involved in the problem and to have the technical skills to solve it.
Yes, teams are incredibly important in scaling and bringing products to market. But that first spark – that initial burning ember of innovation – is formed in the fire of heavy individual investment. These clinician developers are one such catalyst, and I believe that without them healthcare technology will continue to lag 15+ years behind every other industry.
That’s why we formed Clinical Developers. We’re just getting started, but together we are determined to accelerate one another towards success. If you have the skills and determination, now’s the time to start solving the difficult problems only you can selflessly solve. We’d love to help.
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