Proposal: Audit + Medicine

Caution: Rant ahead.

There may already be a job like this, but I’d like to propose the marriage of 2 disciplines: Medicine (specifically from a pathophysiological/diagnostic perspective) and auditing. From my outsider’s perspective, there seems to be a bit of a “long-tail” quandary with medicine - innumerable unique and rare diseases that would require the careful attention of a trained eye for diagnosis, over an extended period of time and observation. And an often-quoted statistic is that doctors spend an average of 15 seconds listening to a patient. To be clear, this is not a conversation about bedside manner, and I have the utmost respect for physicians and what they do. This is instead a gap analysis of an area of medicine that could greatly benefit many people if the niche could be filled efficiently and effectively.

Many diseases have subtle symptoms that sufferers can easily miss - generalized pain or fatigue, all the way to occasional double-vision or tinnitus. Patients are usually tasked with chronicling their symptoms for presentation at their doctor’s appointments, but things can often be left incomplete, forgotten or lost in translation.

Enter the auditor.

An auditor’s job is to dig, to corroborate, to “trust but verify”. Auditors learn the practice (or the art, if you will) of careful observation and attention to detail. They learn to ask the probing questions and document what they experience. And they learn to look for proof, for gaps, and for signs of things good or bad. And all of these could be imminently useful to patients. Doctors learn these techniques in their training as well, but there are obvious cost-prohibitive implications of having an M.D. follow a patient around for days or weeks.

If a compromising position could be created - perhaps an individual with an auditor’s background and specific medical training (akin to a physician’s assistant, perhaps with specialty training in areas such as rheumatology or oncology) - that commanded a modest salary, then perhaps this gap could be bridged. I’d call it something like substantive differential diagnosis (sDDx): the process of observing and obtaining tangible, supportive, and representative evidence of symptoms or disease, to the end of reaching a diagnosis.

Again, I may not be the first with this idea, but it seems like this would be a valued position in the world of investigative healthcare. I must give credit to the following for hatching the notion: Matthew Cornell’s interview with Alexandra Carmichael regarding personal ownership of your health, as well as Alexandra’s projects: CureTogether and The Quantified Self. Great stuff.