One of the trends I’ve seen over the years is the systematic elimination of priesthoods in industry after industry.

I first noticed this with the publication of the book From Wall Street to Main Street by Gene Perry.  He described the transition from needing a broker to buy and sell stocks to being able to do it yourself.  We can see this now in computer programming where programs that used to require deep expertise can now be done by novices with no programming experience.

Many years of my life in several different startups were aimed at changing the nature of the health care priesthood.  I was reminded of this discussion by the article this week on Patients want to read Doctor’s notes, but many doctors balk.

It is the same old debate about whether the “idiot patient” can possibly be able to understand the knowledge laden notes of a professional MD.

David Cochran, MD

Those views were put to rest by Dr. David Cochran who was our Medical Director at Lexant, one of my many startups.  One of the reasons David joined us from his position as CIO of Harvard Pilgrim Health Care is that he had noticed the complete change in his relationship with patients over the previous 10 years.  It used to be that he was viewed as a God by the patients dispensing his hard won knowledge.  Then he noticed that all of his patients were highly educated and that with the advent of the internet they knew far more about their specific disease than he would ever know.  So he changed his practice to be a consultant to the patient.  While the patient knew the facts of their disease along with their signs and symptoms, they didn’t know what to do with those facts.  David had to know and be able to manage several tens of thousands of sign-symptom-disease complexes which meant that he knew relatively little about any one disease but he was well versed in the process of health to illness back to health.  His role became augmenting the patient’s knowledge not pontificating from on high.

I would assert that the classroom is still full of priests and is quite hierarchical.  Somehow we have to recognize the student as the center of the universe (and university) not the professor or the administrators.  That is a huge change from the hierarchical system that we’ve all experienced as students and as professors.  Or stated another way at the core of the redesign of the university has to be the shift to learner centered design which includes having the students take far more responsibility for their learning than most do today.

Cathy Davidson has a lot to say about this process and particularly one of the last bastions of the hierarchical approach which is assessment.  I wrote a little bit about this today on my blog entry on learning and the internet.