Medicine and Silicon Valley: Two cultures with more in common than you think


Apple Inc CEO Tim Cook takes the stage during the Apple Worldwide Developers Conference 2012 in San Francisco, California June 11, 2012.

Article Highlights

  • The five domains of remarkable alignment between Silicon Valley culture and medicine @DShaywitz

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  • The underlying passion to leave the world different than they found it is a common quality in Silicon Valley and medicine.

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  • Most physicians and Silicon Valley entrepreneurs are absolutely “all-in,” their lives revolve around the calling they chose.

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  • Physicians and tech entrepreneurs can have extraordinary impact when working to solve problems together. @DShaywitz

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As a recent arrival to Silicon Valley and its unique culture, I've had the unique opportunity to consider how it contrasts with the culture of medicine, with which I'm deeply familiar. 

I've been especially struck by the excessively reductive view many Silicon Valley engineers seem to have of medicine, a practice many see as fundamentally an exercise in algorithm optimization currently performed rather badly by physicians who are locked in an antiquated mindset, and who are unwilling to relinquish their traditional elevated status, even though it's no longer warranted or relevant. 

For their part, physicians view many Silicon Valley engineers as frivolous, Tolkien-quoting, unrepentant Trekkies who don't appreciate the gravitas of illness, who underestimate the human element of medicine, and who promote consumer-focused health applications because they're too ignorant and fearful to meaningfully engage a system that may be imperfect, but which still manages do to far more good than often appreciated - and arguably a lot more good than Farmville, Angry Birds, or the latest photo-sharing app.

Other than that, Mrs. Lincoln, how was the play?

While it's important to acknowledge and understand the legitimate differences in perspective that exist, I'd argue it's at least as important to recognize the remarkable degree of alignment between Silicon Valley culture and medicine as I've experienced it.  Consider these five domains:

Drive: Entrepreneurs, of course, are driven by their desire to have an impact, and famously, "make a dent in the universe."  Most entrepreneurs who participate in the Stanford Entrepreneurial Thought Leader (ETL) seminar series frame their accomplishments in this context.  A passionate commitment to making a difference was also a defining element of most of the med school applicants I interviewed over the years when I was in Boston, and constitutes an enduring character trait of the physician role models I admire most (including in particular, full disclosure, both my parents).  While it may remain a bit of a stretch to compare the accomplishments of Paul Farmer and Judah Folkman, two more heroes of mine, with those of the founders of Dropbox and Instagram, their underlying passion to leave the world different than they found it seems an important common quality.

Autonomy:  Perhaps the most appealing and resonant aspect of entrepreneurship is the opportunity to author your own life - the autonomy to select what you do, and to figure out how best to do it, within certain constraints.  Traditionally, the opportunity for a similar degree of autonomy attracted many to clinical medicine; while such autonomy has been progressively constrained in most clinical practices, physicians still enjoy considerable flexibility - much to the consternation of many critics, including technologists, who cite this as the source of many of our healthcare woes.   The resistance of most physicians to even the most basic attempts at standardization highlights the value they place on doing medicine their own way.

Empathy: Many of the most successful technology entrepreneurs, from Bezos to Jobs to Hsieh - excelled at understanding what the customer wanted (whether or not the customer was even aware).  A feel for the voice of customer is vital for the success of most Silicon Valley startups - and equally important for the success of most doctors, with deep roots in medicine's best traditions.  In the words of Sir William Osler, "The good physician treats the disease; the great physician treats the patient who has the disease."  

All-in: The hours entrepreneurs put into the business and their commitment to its success are the stuff of Silicon Valley legend - yet follow around a medical resident one (long) day, or a trauma surgeon, or a devoted primary care physician whose pager beeps constantly, and I suspect you'll be struck by both the schedule and the devotion.  Most physicians that I know (and I acknowledge my sampling, deeply rooted in academic medicine in general and MGH in particular, may not be representative) are absolutely "all-in," and their lives revolve are the calling they have chosen.

Disruption: To the extent technologists in Silicon Valley have thought about medicine, they are attracted by the idea that the system is broken, and is "ripe for disruption" - easily the most common phrase I hear.  Funny thing is, most doctors I know agree.  Almost everyone I know in medicine believes that the way care is delivered, and monitored, could and should be so much better, more complete, and more continuous, with much better feedback mechanisms in place, and considerably more patient focus and patient involvement - and much less duplicative paperwork. 

I wouldn't want to gloss over the very significant differences that remain - most notably, physicians are looking for innovations that help them solve problems, while many technologists believe doctors themselves are the problem

Even so, I find myself aligning with the view I've heard most eloquently and relentlessly articulated by Rock Health's Geoff Clapp: constructive engagement is good, already happening, and the best way to make a difference. 

I agree.  I've long believed that medical schools should provide greater exposure to entrepreneurship and to entrepreneurs - see this 2005 op-ed (co-written with my MGH colleague Denny Ausiello) entitled, "Entrepreneurs: Missing Link in the Training of Medical Scientists."   As medical trainees increasingly fret about the world they're preparing to enter, it's difficult to think of seminars more relevant or inspiring than the Stanford ETL series, or a more uplifting and humane world view than that offered by tech VC Brad Feld's blog and associated publications (then again, what do you expect?  His father is an endocrinologist).

Yes, the challenges we face are daunting - but I believe in the power and the passion of physicians and tech entrepreneurs, and the extraordinary impact they can have working to solve problems - important problems - together.


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