Friday, December 28, 2012

Maintenance of Certification and Quality: There Are Two Sides

I had written a previous post on this subject earlier, but with two articles out this week in premier journals (the New England Journal of Medicine  and JAMA), I am seeing some interesting chatter on Twitter from well-respected physicians describing the downsides of Maintenance of Certification, or MOC.  Here are two previously written blogs (#1  and #2) outlining these “downsides”.  It is clear to me how these physicians feel about the MOC process.
There could be many ways to discuss the issue of MOC in this blog.  I will try to focus on simplicity: “for” and “against”, along with literature that highlights each of these arguments.
Arguments challenging the current process of MOC
1.       It takes physician’s time away from direct patient care.
2.       It is a “bureaucratic scam”, due to the fact that it is very costly, with the beneficiaries of monies being the leadership of the Boards comprising the ABMS (American Board of Medical Specialties).  [Interesting that this article is not referenced in PubMed, but can be found through standard non-medical search engines.]
4.       It has not been shown to benefit patients or patient care.

Arguments in favor of the MOC process
1.       If not the current ABMS MOC process, then there exists the possibility that other regulatory agencies (such as OSHA) could dictate how physicians should practice (see quote in article by Dr. Robert Wachter). 
2.       There exists a correlation between higher scores on MOC examinations and quality of care. (Article 1 and Article 2).
3.       Physicians who spend the majority of their time in practice, not just “academic types”, validate the content of MOC examinations.
4.       The farther out a physician is from training, the lower is the quality of care provided.  While this seems to be a pretty harsh statement against the “there is no substitute for experience”-argument, the current literature does support this position.

I am sure that there are many other arguments for and against MOC.  This blog is not intended to be a mathematical "weight comparison" of articles on the topic.  My own opinion on this is simple: physicians need to engage in lifelong learning (Article #1 here and Article #2 here), under the “Practice-Based Learning and Improvement” competency.  Whatever the ideal process should be for this, I cannot say with certainty, but I would much rather have those within my own specialty, who also understand educational methodologies, regulate ongoing physician certification, rather than others that are removed from the day-to-day challenges of the current practice of medicine.  The current leaders in my specialties, who dictate the regulations as they currently stand, are the ABIM and the ABP.  This was summarized in my Annals of Internal Medicine letter to the editor earlier in 2012. 
So what do you think about the process of MOC as a way for the ABMS to hold physicians to a standard acceptable to the public?  Is it working well?  If not, what could be improved?

In full disclosure, I am not employed by the ABIM or any of the ABMS boards.  I personally know one member of the ABIM, from his days as a former program director.   I have not written examination questions for the ABIM or the ABP.  I get no royalties from the ABIM, the ABP or the ABMS, and have no stock in these companies or any of their subsidiaries. 

Wednesday, December 12, 2012

Twitter within Academic Medicine

I have had the opportunity to do several presentations about Social Media in Medicine and Medical Education.  I am currently set to give a Grand Rounds for Neurosciences at the IU School of Medicine in just a few minutes at the hashtag #IUNeuroscienceGR, with audience members in neurology, neurosurgery, physical medicine and rehabilitation, and psychiatry.  We will be having a live Twitter feed broadcast to the audience.  I am excited to provide information about this topic to this multidisciplinary audience, but even more interested in learning from the audience about how Twitter is perceived within the neurosciences sphere of academic medicine.
A recent article about the use of Twitter at medical conferences highlights this phenomenon.  In addition, it was great to present at the Med2.0 conference back in September 2012 about our experience with Twitter at Grand Rounds within pediatrics at the IUSM.  I am aware of others beginning to delve into this area, including Eastern Carolina University within their Department of Medicine residency program.  Recently, one of our graduates, Dr. Joel Topf, now a nephrologist in the Detroit area, presented a similar grand rounds on the use of social media within health care.
In addition, two days from now, I have the privilege of participating in a Tweet Chat on the topic of depression, to take place on 12/14/12, at 3 pm EST, under the hashtag #IUHedu , with Dr. Joanna Chambers from our Department of Psychiatry.
It is exciting to see Twitter being used as a tool to disseminate information to health care providers and also to patients, and also that others are seeing the impact of this on how physicians and other health care professionals learn.  The more that we can get the word out about the power of sharing healthcare information in this venue, the better.  Now we just need to demonstrate improved patient care outcomes from it--that's the hard part!

Saturday, November 17, 2012

Reflections on #AAMC12 - Social Media in Medical Education

It has been a very busy few weeks, but certainly one filled with learning, teaching, disseminating, and advocating.  The American Association of Medical Colleges meeting finished last week, and this blog is my attempt at some brief reflections after recovering from the onslaught of email after the meeting, followed by some great interviewing for the residency program.
Given my interest in social medicine within medicine and, specifically, medical education, it was a phenomenal opportunity to hear what others are doing, what others are thinking about, and how we can overcome challenges and turn them into opportunities.  During one of the plenary sessions, I had the privilege of meeting and tweeting with Dr. Bryan Vartabedian, who blogs and tweets about medicine and social media.
The plenary speakers were just wonderful, and provided provocative, stimulating ideas for the audiences.  I tweeted comments from a few of these during the meeting.
I attended great workshops on feedback and quality and safety within CME.  I facilitated a session on Research in Medical Education (RIME) session on Continuing Professional Development with some very eloquent speakers, and learned much of what others are doing to change behavior and improve learning.  I also heard from Dr. Kendall Ho from the University of British Columbia about his work in e-Health and m-Health, considering what is currently available in the current generation, as well as what may be the reality in the very near future. 
I had the great privilege of facilitating a workshop on Social Media in Medicine with my colleagues Dr. Ryan Madanick and Dr. Terry Kind.  Both of them were gracious enough to come to this meeting and provide their experiences to the audience.  Many faculty came to hear about this topic, and provided stimulating conversation about the challenges and opportunities.  We discussed professionalism, competencies, the meaningful use of social media for physicians, and specifically, for medical educators, and we had a challenging goal of teaching participants how to use Twitter.  Several of them were able to do so by the end of the session, and indeed sent out their first tweets.  This was great, and we felt that we accomplished our goal.  We also learned that it was hard to answer all of the questions while trying to get through the basics of Twitter, explaining hashtags, DMs, mentions, and the like.
In the very last session, I was able to hear faculty from Albert Einstein College of Medicine (Martha Grayson and Liz Kitsis) and Kathy Chretien from George Washington University speak about professionalism within social media, as well as a robust discussion on doing faculty development on social media.  Einstein received a Macy Foundation grant  to study this topic, and have embarked on a wonderful journey.
Also, I was able to meet Kelly Stazyk from the AAMC, who is integrally involved in the intersection of social media with career advising for medical students.  I also had a chance to spend a half day meeting with a group from the AAMC reviewing implementation science and how it links with medical education.   Despite the fact that very few of us knew each other, we came together to discuss, critique, and help each other in writings on implementation science.  What a collaborative group!
Since I have been back, it has been a time to reflect on what I learned, what I can take home and implement myself into my own work, and how we can optimize teaching of medical students, residents and faculty.
So how often do you really reflect on what you have learned and what you can do differently when you return from a conference?  I think it is an integral part of being a professional, even when many things await you upon return.  A time for a commitment to change has never been more important.

Tuesday, November 6, 2012

Teaching, Learning, Advocacy

I am currently in San Francisco at the Association of American Medical Colleges (AAMC) meeting.  This is a meeting of medical educators, and is a wonderful conference for my personal learning plan.  I have truly enjoyed my time, learning a ton about the field of Continuing Medical Education, catching up with old friends, and meeting many new friends.
I have had the opportunity to be on a panel, hearing Dr. Kendall Ho talk about e-health, what is here now, and what may come in the future.  I also had the great privilege of moderating the Research in Medical Education (RIME) session on Continuing Professional Development, with provocative speakers on a variety of subjects.  I had dinner with the leadership of the Indiana University School of Medicine yesterday, meeting other new medical students who are the future of medicine.
Today, I couldn’t be more excited to give a workshop with my colleagues Dr. Terry Kind from George Washington University, and Dr. Ryan Madanick from the University of North Carolina, on the topic of Social Media for medical educators.
Our message: we need to be in the digital space, to connect and communicate with patients, with learners, and with each other.  To teach, to learn, to advocate.  These are critical components of being a health care provider, and something I am proud to talk about.
To teach, to learn, to advocate.  As today is election day, and many will exercise their right to decide the future leadership of the United States, let us be reminded about the importance of advocacy, teaching and learning.  It is why many of us are here at this meeting, and how we re-energize our bases to go back to our institutions and care for patients to the best of our abilities.

Friday, September 21, 2012

Med2.0 (#Med2) -- An Annotated List of Blogs from Med2.0

It has been almost a week since Med2.0.  For those that don’t know, Med2.0 is a conference about using technology in medicine to further and improve patient care and education.  This was my first time attending this conference.  What a wonderful experience!  I had the opportunity to meet some of my physician colleagues whom I had previously not met in real life, but that I knew through Twitter.  In addition, there were others with expertise in other areas from whom I learned so much.
Since the meeting ended, many have written blogs about their experience.  Below is just a smattering of blogs written by a few attendees, reflecting on the awesome experience.

Specific Situations
Hallway Conversations. This blog from @kidney_boy describes the evolution of an educational resource tool, Dynamed, which occurred as a result of a hallway conversation.
Blogging: The “A-HA” Moment about Online Histories.  I wrote this blog halfway through the conference, after reflecting on a panel session on patient blogging and on the importance of asking patients about how they use the internet to search for health information.
Healthcare Needs Social Media.  This blog, by a well-known blogger and pediatrician, Dr. Claire McCarthy, describes the importance of relationships and communication in medicine and how social media aids in improving these.
Thoughts on QR Codes. This blog by @kidney_boy describes how placing QR codes into slide presentations worked well (and not so well) for participants.
Online communities This blog, by @colleen_young, describes how communities through the internet can support individual participants.  Colleen also won an award at the meeting for her work in this arena.  Congrats, Colleen!

At the end
SketchNotes: This blog, by @cassiemc , includes a wonderful pictorial sketch that is worth its weight in gold!
E-Patient  This summary, from Joe Graedon from @Peoplespharmacy summarizes take home points from Day#2 of the conference, highlighting the Society for Participatory Medicine.

General Reflections on the Conference
Student impressionsThis blog by @HodaPharm , describes Hoda’s first-time experience at the conference, with reflections on many different presentations.
Gut Check This blog, by @RyanMadanickMD, a colleague of mine interested in the intersection of medical education and Twitter, summarizes how he learned from people with entirely different interests.
Summary of several individual sessionsThis is a wonderful summary of many sessions attended by @kidney_boy, who blogged this piece for the AJKD at @eJKD .

I am sure that more will blog about their experiences, and hope that this summary provides helpful information for those there, as well as those who were not able to attend.  Please post any comments.  Thanks.
Alex Djuricich

Sunday, September 16, 2012

The "A-HA Moment" about the OH ; Blogging

I am currently enjoying my time at the Med2.0 conference in Boston.  This great group of folks  is coming together to learn and disseminate how to leverage the power of emerging technologies to help improve patient care.  It is simply eye-opening to learn and understand some things coming down the pike which will help health care professionals care for patients in the future.

I attended a session on Blogging by patients which has me thinking.  One of the points that was brought home was that patients with chronic illnesses are blogging about their experiences with having certain health conditions, and that blogging has a powerful effect on how they self-manage their illnesses.  To me, this is VERY powerful.

In another session, a focus was on how many patients are searching for online information about an illness.  I have said this many times, and will say it again here.  The medical community has a duty and an obligation to dispel mis-information which is unfortunately so prevalent on the internet, and to provide simple, truthful, meaningful messages that patients can understand.  What better way to do this than through the use of social media.

One way to know about whether patients are looking online, or posting online through a blog, is to take on online history, or OH.  We should ask patients whether they do this, just like we should take a social history when we first meet them.  This can help us learn about how patients deal with their illness, and how we might be able to best help them.

This is my "A-HA" moment about the OH.  If you are a health care provider, you should consider the importance of the OH: it will be your A-HA moment too, and it will better help you get to know your patient.  Isn't that what the Patient-Doctor Communication is all about, after all?

Sunday, September 2, 2012

Computers in Patient Care

I’d like to start this blog with a comment that I am a strong proponent of using emerging technologies to help improve patient care.  I believe in the power of mobile computers to help us with patient care.  I believe that we should use technology to augment the care we provide, not replace it.  However, I had an interesting hallway conversation with one of my fellow attendings earlier this week, which caused me to reflect on this topic, and ultimately write this.
Electronic medical records are touted to help improve efficiency, to be able to collect information to help us improve the care we provide, as well as other positives that are well-described.  The government is even providing incentives to health care systems and physician practices for “Meaningful Use”.  I have believed in the power of computerized physician order entry, or CPOE, for a while, having had it at one of our training hospitals when I was training in 1994 – 1998.
However, the discussion I had the other day made me really think.  Trainees (and attendings, as well; we are not any different) spend so much of their day on the computer, and this appears to be coming at the expense of face-to-face time with the patients.  This article suggests that direct time with patients is not ideal for residents on call, and that much of the time on call is spent in front of a computer.  12% of the time was spent in direct patient care.  12%!  I am concerned about this, and I bet patients would also have similar concerns.
This article, with a drawing by a child highlighting what they see with regards to doctors and computers, pretty much sums it up: even children are noticing that doctors are “tethered” to the computer.  This has to change! 
I do believe that we can fix this.  It starts with acknowledging this “elephant in the room” (or, more aptly, the “computer in the room”).  I am currently spending a few weeks on the inpatient service at our county hospital, and had the chance to discuss this with our medical students.  We made sure that rounds on patients including going to see the patients and interact at the bedside, not just exclusively sitting around a table discussing the patients.  We discussed motivational interviewing (and demonstrated it) and getting to know patients as people.  We reflected on why all of the students went into medicine, and none said “to type information into a computer.” “Stop and smell the roses” was the take-home message of the day, the roses being, among other things, time with patients.
Please, please make sure that staring into a screen doesn’t replace sitting at a patient’s bedside.  Please make sure to talk to your patients, to look them in the eye, to ask them what they think, and to answer their questions.  It will help the patients, and it will promote the humanism that is at the heart of the patient-physician relationship.  Yes, computers and mobile tablets can help us care for patients, but in my opinion, there is a bond between a patient and a physician which should never be replaced by a computer.  Let’s not break that bond!

Monday, August 20, 2012

Faculty Learning in Social Media

It has been a great last week for me.  I have successfully returned from vacation and have come out of “email jail” relatively unscathed.  I begin a short two-week stint on the inpatient medicine service in a few weeks, and am using this week to get caught up on some important activities soon to come.
First, I am excited to be giving a Grand Rounds presentation at Columbus Regional Hospital in Columbus, IN, in a few days on social media in medicine and medical education.  It has provided me with an opportunity to reflect on all of the information I have collected on the topic over the past year or so.  We will be live tweeting the event at the hashtag #CRHGrandRounds, at 12 noon EST on 8/22/12, and I look forward to the discussions both in person and online from that.
Second, I am pleased to report that we are rolling out a Faculty Learning Community (FLC) in Social Media for IUSM faculty members.  I had the privilege of belonging to a similar FLC in the use of iPads in medical education for the past two years, and it was widely successful.  With this new project in Social Media just starting, the hope is to learn from others, and move forward scholarship with regards to using social media within medicine and medical education.  We are starting it off with a presentation on how to use Twitter in medicine, followed by applications from faculty members who want to join this FLC, starting the actual group out in October.  I am extremely honored to be leading this FLC, and hope that we can determine some real areas for research around social media and follow through on that research in the coming year.  For example, how do we best teach students and trainees about using social media without compromising professionalism?  How can physician use of social media impact direct patient care in a positive manner?
For my fellow faculty at the IUSM: please send in an application if you are interested in how social media impacts your teaching and learning!  I am curious for those faculty out there at other institutions: have you done a similar thing to these learning communities, and what were your successes and failures?  What worked well and what didn’t work so well?  Please comment so others may learn from what you have accomplished.

Saturday, August 11, 2012

Transition Care

Yesterday I read an interesting blog piece about a patient struggling with the transition to adult care.  As a Med-Peds physician, I am acutely aware of this issue and attempts to improve such processes.  Our institution has a team that specifically addresses transition patients, and helps ease the move to adult care.  Here at the Indiana University School of Medicine, it is called the CYACC clinic, or the Center for Youth and Adults with Conditions of Childhood.  CYACC’s mission is to steer youth with special health care needs towards a successful adult life.  Some of my Med-Peds colleagues at Indiana University care for patients in this clinic, specifically Mary Ciccarelli, Katie Weber and Jason Woodward.  Although I personally am not involved in this clinic, I have worked with many of the people there, and feel that our institution is lucky to have health care personnel dedicated to this particular patient population.
There are other institutions which have similar clinics; a few examples include Baylor and Christiana Care in Delaware, to name just a few.  I do believe that Med-Peds physicians are a natural fit for helping manage such patients in their transition journey (and are the main drivers who direct these clinics).  Specific teams (which include other disciplines besides physicians) such as CYACC are wonderful for guiding transition patients through the health care maze that clearly exists.  By highlighting these services and serving patients, patient care can be optimized, and patients can be prepared for next steps towards independent adult life.
I am curious how many patients are aware of clinics like CYACC, and whether such a clinic exists where they live.  Please comment.

Sunday, August 5, 2012

Vacation and Getting Time Away

I realize that it has been a while since my last post.  Work has certainly been very busy with many projects and deadlines.  However, currently, I just returned from a vacation in the Caribbean, in the Dominican Republic.  This is such a beautiful country, and my family and I had  a wonderful time in this paradise.  We enjoyed some quality family time, and I really only looked at email and work-related activities a few times while there.  It was actually a challenge to be “unplugged” from the world of medical education and technology.  However, I do believe that it was good to do this, and to be away from work.  I certainly know that it is healthy to do so.  Years ago, there was no option to do anything but, but nowadays, with wireless access, people can be connected 24/7, including on vacation.  I promised myself that I would try hard to check email only a few times during the vacation, and was true to my word. 
I planned for an international connection via a wireless hotspot, but apparently it did not work.   There was wireless access at our resort, but not in the actual unit where we stayed.  It was an eye-opening experience to not have it, not just for work-related things, but for social media and for keeping up on the news.  I now realize how I get my information, in “bite-size chunks” via Twitter and other social media channels such as Zite.
I felt a stronger connection to my family this past week.  My oldest daughter learned how to dive, and is getting quite good at it.  My youngest can swim without having to watch her like a hawk. Sit down meals have been great!  Earlier this week, at the beach, we met a delightful couple from New York, and had some stimulating adult conversation.
So my question for all is this: when you go on vacation, do you “unplug”, or do you continue to stay connected to work through email and other methods?  What do you enjoy doing when you do get away, and how hard is it to come back to your real world after an extended period away (for example, for one week)?
I hope that you make sure to find time for yourself to have a vacation, as it is healthy to take time off for oneself to recharge.  I certainly did so this past week!

Saturday, July 7, 2012

Personal Health

This post is slightly different than my usual, focusing on personal health.  I recently received a wonderful gift for Father’s Day, a pedometer which links via bluetototh with my smartphone.  Given my interest in quality improvement, this has really helped me with measuring exactly how much I am exercising.  What I love about it is the opportunity to compare day to day, and to set and achieve different goals.  Personal accountability is a great thing.
In addition, it has been a privilege to watch my two girls advance in their dance class and learn self-confidence by performing on a stage.  This has prompted me to actually join in as well; I have taken the plunge, and began taking tap dancing lessons (for those that know me, I have two left feet, so this does not come easily to me at all).  I absolutely love this class, despite never having taken any dance lessons ever!!  It is such a great opportunity for me to get away from work (even if for a short time) and focus on myself and my own health, while learning a new skill.  But it provides the added advantage of the girls seeing their father exercise (believe me, this class is a total workout), prompting them to want to exercise more themselves.  I am not even mentioning the opportunity to get to know better the other adults also taking the class with me.
I do believe that we can better counsel our patients about the importance of exercise if we actually exercise ourselves: these are just a few ways that I have done so.  So what do you do to focus on your own health that you talk to your patients about, and what exercise regimens get you jazzed up?

Monday, June 18, 2012

Thoughts on Incoming Intern Orientation

This particular week is the week that the new intern physicians arrived, and become oriented to clinical care. Ours start on June 24 with managing real patients. They are brimming with excitement, but also have a lot to do during the week.

It is interesting to hear from the "old guard" about how it used to be. "My
orientation was 'here is the ER, and here are the bathrooms: now go and see some patients.'" While I certainly would not think that such an orientation is acceptable nowadays, I have to reflect on what exactly we now make the new interns go through.  HIPAA training, ACLS, PALS, NRP, FIT testing, composites, meal cards, explanation of the numerous (not an exaggeration here) computer systems and log-in codes that are necessary are literally just a small part of orientation--and that doesn't even include Handoff training (my personal area of interest).  I mean no disrespect to our hospital administrative personnel by these comments, but am constantly reflecting on what we could do better for our incoming learners.

So what do they actually remember? While as educators we certainly do feel that it is important to have them learn why HIPAA training is critical, or that they have to foster professionalism within the context of social media, I do think that what currently exists truly is an overwhelming mass of "do this, don't do that, you must sign this, you must complete that." So how much do they really retain, when we KNOW that many learners lose interest after a very short time (adult learning theory tells us this)?

Does making interns sign a "I heard this info"-form really help? Does "don't forget to do this" really mean translation of knowledge? Will taking multiple modules online actually help when they won't be back to that particular hospital for 5 months? I'm not so sure.

If anyone has better ways of completing this training in an environment that
promotes retention of information, believe me, I am all ears. I suppose that a similar situation exists in starting other new jobs, and new hires are frustrated. What is so telling is that so many come back later saying "if only I had known that information during orientation, then I wouldn't have done X".

So how long are your orientations, and what do you do to make it educational and fun? Do you feel that the interns complete orientation ready for direct patient care within your system?  Personally, I am looking forward to the "10 things you ought to know about internship"-talk that one of the CURRENT residents is giving later in the week. I would be willing to bet that that is the most useful "orientation" information that the incoming interns will actually get for the entire week, despite months of planning and trying to fit so many “required” things into the week.

I am curious as to any ideas that others have. Believe me, everyone is learning here, and this is after knowing for 10 years exactly what previous trainees have told us about orientation.  I’m sure other educators out there have similar thoughts.  Please let me know your ideas.

Tuesday, June 12, 2012

Learning from Technology in Education

Yesterday, I had the privilege of attending a conference hosted by my children’s school corporation on the use of tablet computers/iPads in education.  As a medical educator, this absolutely piqued my interest.  In addition, as a parent, I have a big voice in how my children are educated, and want to know how I can help.  As it is now, my children are pretty tablet computer-savvy, and are always asking “Can I borrow your red iPad?” 
This conference was nothing short of incredible!  I learned so much, from how to get organized, to how to use video conferencing, to what apps are helpful for children in 3rd grade.  The keynote speaker was truly inspirational, with a wonderful message that “technology is always changing, but teachers will never be replaced.”  This was so great to hear, as an educator myself.  I also loved seeing teachers from all over Indiana come together to learn for themselves and ultimately for their students.
It is my opinion that the medical education world can learn from what the Center Grove Community School Corporation put on yesterday.  The focus was how to embrace technology in order to connect, create and collaborate.  I saw my kids’ teachers there as well, which was invigorating to see that other educators take an interest in their own personal professional development.
As a take home, I am now jazzed up to learn more about how to use tablet in education, for my own personal learning network (I love the phrase “personal learning network”, which is similar to medicine’s “individualized learning plan”).
To the organizers of the iPossibilities Conference at Center Grove, thank you so much, from one education arena to another.  I have taken away so many great ideas from your conference, both for helping my own children learn, and also for my day-to-day work as a medical educator.  I hope to be able to put on a similar conference within medical education, to demonstrate what is possible.  Our learners deserve nothing less!
[To learn more about the iPossibilities conference hosted by the Center Grove Community School Corporation, which was funded through a grant from the Department of Education, and to see handouts, please click here.]

Saturday, June 9, 2012

Graduation and the Cycle of Residency Training

Our residency program and our residents completed graduation ceremonies this past week.  They were wonderful: many faculty attended, and celebrated with the finishing trainees about to embark on future careers and further fellowship training.  I always enjoy seeing how mature the residents are when they finish.
Some are appropriately nervous about what the “real world” of medicine will bring.  Some are giddy with excitement with the opportunity for more training.  Some are excited to be staying here, and some are excited to be moving elsewhere, whether it is a new place, or “back home.”
Regardless of what they eventually do, this is truly the culmination of four years of hard work.  They are ready to be independent practitioners.  They are ready to care for patients to the best of their abilities with no more required supervision.
Congratulations to the Indiana University School of Medicine Med-Peds Residency Class of 2012!  You will go on to do some great things, and will certainly be missed.  We are proud of your wonderful accomplishments, and your outstanding patient care.
Oh, and later this week, the cycle repeats itself, as a new crop of interns (the Class of 2016) begins orientation.  I can’t wait!

Monday, May 28, 2012

Seat Belts: What's The Big Deal?

I wonder how often doctors speak with patients about wearing seat belts.  We all know it is important, and most states have a law requiring that a seat belt should be worn. (click here for information about each state’s seat belt requirements).  In a busy clinical practice, talking about preventive care (such as why wearing seat belts is important for safety) is difficult on top of all of the other things patients want to talk about.  But it is important.
The use of seat belts is one of those habits that most people just do.  You get into the car, you put on your seat belt.  It is that simple.  If we don’t get into an accident, then all is fine.  But what happens when we are unfortunate enough to be involved in an accident?
A recent teenager death from an automobile accident in an Indianapolis suburb hit home to me as a physician who cares for teens.  The teenager who died was not wearing a seat belt.  Over the years, I have also cared for patients who likely would have died were it not for wearing a seat belt.  Their stories are compelling.  In addition, my oldest daughter was in a car crash a few days ago.  She had one minor bruise, but otherwise was unharmed physically.  She was in an age-appropriate booster seat, wearing her seat belt.
It makes me think: why are people choosing to not wear a seat belt?  Seat belts save lives.  So do air bags.  Research clearly demonstrates this.  The use or lack of use of seat belts is a public health issue, which has the potential to impact anyone, regardless of socioeconomic status.
This issue has certainly impacted my family and my practice.  Please, if you get into a car, take the few seconds it takes to click in your seat belt.  As a physician who spends time providing advice to patients, this one is a no-brainer: wear your seat belt when you get into a car—every time, with no exceptions.  It may save your life.

Saturday, May 19, 2012

Medical Administrators – Should They Still Care For Patients?

I have been relatively absent from social media for the past week or so.  I have been doing inpatient duties on a general medicine service, and really enjoy working with medical students, interns, residents, pharmacists, and inpatient floor nurses.  It has been a wonderful opportunity to experience the day-to-day activities involved in hospital medicine, and of course, to see and care for patients.
The time on the inpatient service is demanding, both physically and emotionally.  Managing ill patients, long hours caring for complex patients and updating their families leave little time for my other duties in overseeing a CME office and a residency program.  I am trying my best to juggle all of these duties, but for now, the patient care priorities do come first.
As I was arriving one day this week, I saw the chair of another department coming in, and mentioned that I was on service doing inpatient work.  He remarked: “So good to hear that you are continuing this great work, and that you are still actively involved in patient care.  Keep it up!”  That made my day.
So I have been pondering this: should physicians who have major administrative duties and oversee programs, and thus have major time devoted to such activities, still care for patients?  Should they still remain clinically active in order to have “street credibility” with their mostly clinical colleagues? 
I think the answer to this is “yes”.  As busy as it is, I still believe that it keeps me fresh.  It allows me the opportunity to reflect on why I went into medicine in the first place.  It allows me to still remember what it is like to talk with a worried family member about a loved one, to see the gradual changes when a patient improves from hospital admission to discharge.  It allows me to also see the trainees doing what we want them to do: learn to care for patients.
The more I become involved in overseeing administrative programs, the less time I can devote to direct patient care.  But I still really enjoy doing the day-to-day patient care, and working with trainees as they learn the art and science of medicine.  I still haven’t forgotten the old adage by Francis Peabody: “The secret in the care of the patient is in caring for the patient.”

Wednesday, May 9, 2012

Medical Conferences: What Are Your Take Home Points?

I attended a local conference today sponsored by our Department of Pediatrics and Riley Hospital for Children.  Many of our residency graduates, especially those who live and work locally, return for this meeting.  It really is great to see our graduates and what they are up to.  I enjoy hearing about how they have transitioned to practice, and learning about their own successes and challenges.
This particular year, I was not a presenter, nor did I run any workshop.  I went to this conference strictly to learn.  It was simply wonderful to do so.  The day started off with a dynamic visiting speaker reflecting on the state of well child visits and potential innovations around how to be more effective with these, especially given the changes in medicine that are occurring and will continue to occur.
One might think that this topic is not all that interesting (which the speaker himself even acknowledged).  Plain and simple, I was inspired!  It brought me back to why I chose to go into medicine in the first place: to make a difference. Other extremely well-presented sessions reminded me of things I should be doing when encountering patients with specific conditions.  A lunchtime talk on mentoring solidified a successful day for me (and that was only halfway through the day!).  Other great “high-yield” topics in the afternoon piqued my interest as well.
When some people come back from conferences similar to this one, they realize that while the conference was wonderful, there is still a stack of paperwork that needs to be completed, that there is more work to be done, patients need to be seen, and emails must be answered.  I also have all of those things looming over me.  But I also gained a sense of purpose, connectedness, and excitement for the future of medicine from the conference.  In addition, I learned some new things, was reminded of things I should already know, and also heard about changes coming in the future.
What do you get out of going to conferences besides the acquisition of information?  What other “informal curriculum” things get you jazzed up, and how can conference organizers effectively capture that for other attendees?  I am curious if others see this similarly or differently.

Tuesday, May 8, 2012

A Medical Educator Joins Social Media: One Year Later

I just realized that yesterday was my one-year “anniversary” for joining Twitter.  Wow, what a ride it has been.  I have learned so much in this short year.  Here are a few take-home points:
1.      If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are.
2.      Despite #1, there are late adopters who feel that social media is a “waste of time” for physicians.  That is ok.  Forcing them to “do social networking” will not be fruitful.
3.      Social media is a fantastic way to meet other like-minded individuals who have similar interests.  I never would have met a great group of people (some in real life) had I not joined social media.
4.      Patients crave information about their health.  If they want it via social networking routes, we should offer it to them.
5.      There is a lot of mis-information floating around on the internet.  It is a duty of physicians to combat this and provide correct information.  I fail to understand why physicians don’t embrace this more: it is advocacy in the truest sense!
6.      If you decide to join social media, start slow, but start.  It will take a while, like riding a bike is not learned in 15 minutes.
7.      Do not let social media take over your life.  The important things (family, friends, etc.) are still the important things, so don’t lose the priorities.
8.      Push the envelope.  It is time for curricula in social media within medical education to be formally written, and also to be disseminated.  Policies or guidelines are one thing, but curricula are another.
9.      There are many “tools” to make it easier to integrate social media into “what you do”.  Pick one or two, and use them.  It will make the process less overwhelming.
10.   Have fun!  There is some great learning, and in addition there are some fun people out there, and I am a better person for having met them virtually.

Sunday, May 6, 2012

For Your Health

Today’s post is a little off the usual theme of Medical Education.  But then again, maybe it isn’t.  Why are those who do medical education involved in teaching others?  Among other things, because they enjoy the love of teaching.  I certainly do.  Today’s post is teaching by doing.
Yesterday, I ran in the Indianapolis “Mini-Marathon”, a 13.1 mile half marathon which is supposedly the largest half-marathon in the United States.  Wow, what an incredible day.  I have run it before, but there was something different about yesterday.
I got there early, after waking up before my alarm woke me up.  I stretched, got my stuff all ready to go (including having my phone with me, as well as gel packs), and was ready to go in my corral early.  I didn't see as many people that I know as I usually do.  It was great to see Dan Fulkerson, one of our Neurosurgeons.  In the corral, just before the start, I found another one of my Riley Hospital colleagues, Dr. Scott Walker, a pediatric anesthesiologist, and met his family.  An incredible sight of the race just before the start is here.
In the past, I have tended to come out too quickly, and I was determined not to do that again.  The first mile was just about where I wanted to be, and the next two were perfect.  I was feeling great at this point, and was on track to meet my goal.
For me, the nemesis has been the race track, which is just before mile #6 until just after mile #8.  I was determined not to slow down on the track.  I made it to the Yard of Bricks at a time which was perfect for me.  I felt really good at this point. 
Then I just plain petered out, along with many other runners.  I walked the water station at the end of the track, and just couldn’t recover.  The heat had gotten to me, and I simply couldn’t go any faster.  My legs were aching, along with my feet.
My GPS timekeeper shows the times from Mile #9 through the end with slower times during each consecutive mile.  This was a bummer, but I think that the lack of long training, and the heat took its toll on me.  But the atmosphere was just incredible.  It was wonderful seeing people running for causes, running for loved ones, running for their own health, or running "just because."  This alone is a reason to run the Mini.
For example, I saw military personnel decked out in full gear, with heavy backbacks, who did the entire race with this gear!  I saw a man who had an obvious stroke but who kept trudging along (actually passing me!).  I saw kids pushing their parents on.  I heard so many words of encouragement and songs from the many bands and cheerleaders along the way.  My favorites: the Circle City Cloggers, and the high school students decked out as Christmas ornaments!
So why have I continued to run the Mini-Marathon?  I am certainly sore afterwards.  It definitely takes a while to train for this (lesson for next time: train a bit longer, focusing on the longer distances).  Is it the thrill of running?  Is it the excitement?  Is it all of these things, plus some unknown factor?
Who knows?  I’m not sure, but I just signed up again for next year!  Here’s to my health and yours!

Monday, April 16, 2012

Interprofessional Education (IPE) – Learning How to Do and Teach It

Last week I had the incredible privilege of attending a workshop on interprofessional education (IPE). Although I believe that I have been inclusive of the views of other heath care professionals, this workshop opened my eyes to new possibilities for how we educate the future health care professionals in all areas.

First of all: kudos to the absolutely amazing people from the Centre (note Canadian spelling here, eh?) for Interprofessional Education at the University of Toronto.  Ivy, Mandy, Lynn and Belinda were just wonderful people to get to know (absolutely some of the friendliest people I’ve ever met).  They truly embody what the world of working together with other backgrounds can and should entail.  Their work is truly inspiring, and is all the more impressive given the limited amount of dedicated time that they have to do it.

Second, it opened my eyes to some awesome people who are already here working for my own institution (Indiana University), whom I had not yet met.  It is fascinating when people work so hard in their own arena and do not know that others with like-minded interests are sometimes literally right around the corner.

Third, it reinforced the belief that no matter what health care field one may work, it is still all about the patient!  I am reminded of this every day in my work, and this workshop cemented that even more.

Fourth, it is exciting to see that my own institution has a plan for how to embed IPE into the curricula of the medical school, the nursing school, the school of social work, the dental school, the school of optometry, the school of rehabilitation sciences, and others (we do not have a school of pharmacy).  There is much work to be done, but we are well on our way.

I was not originally scheduled to go to this, but had the privilege of attending portions of the workshop.  I am so glad that I did, even if I missed some of the sessions for patient care duties.  It has invigorated my interest in what I do in medical education.  And isn't it great to be invigorated every once in a while?

Here are two links on IPE in medical education.

Sunday, April 8, 2012

Disseminating the Message

I have had a blast the past few weeks.  I enjoyed a great vacation with my family.  I was privileged to give a Grand Rounds presentation on how doctors can use social media responsibly to improve education and health in general.  What a great opportunity, capped off by several across the country watching the live stream and others live tweeting specific points from the presentation.
Today, a segment on physicians using social media is airing on the radio show Sound Medicine.  I have to say that doing this segment was simply a phenomenal time, and an honor to work with the incredible people from Sound Medicine.  Nora Hiatt, Barbara Lewis, and of course, Dr. Kathy Miller, are complete professionals, who left me wanting to come back as soon as possible to do another show.  The radio show that is Sound Medicine is an example of what is good in medicine, and how we can educate not only other health care professionals but also patients and families.  Click here for more information about Sound Medicine.
So what’s the point of this post?  Disseminate the message.  Make it simple.  Social media can really help medicine and ultimately, patient care.  Doctors should not blindly jump in without a plan, but should definitely consider joining in social media to deliver information, ideally for the betterment of patients.  It is an opportunity to provide factual content to a place where many of the patients currently exist: on the internet, looking up health information.  We have an obligation to our patients to educate them how they want to be educated: let’s make good on that obligation.

Wednesday, April 4, 2012

The Costs of Health Care – Change Can Occur

Health care is currently undergoing much change.  Unfortunately, the care provided in the United States ranks not as high as expected given the costs.  The US health care system is the most expensive in the world.  Yes, we have amazing medical centers here, and incredible research is done here, with successes seen every day.  But, along with those successes come the harsh reality that care is uneven for the entire population, simply costs too much, and this is affecting our entire country.
Health insurance costs are through the roof.  It costs so much for a family to comfortably cover health insurance costs, as to be prohibitive for many.  Companies are struggling to be able to provide health insurance benefits to their workers and families.  Some patients choose not to have health insurance due to excessive costs.
No one REALLY knows how much specific treatments and diagnostic tests cost (and even then, the costs vary significantly from place to place).  Doctors order things every day, without understanding what the cost is to the patient and to society.  Patients get billed for many different services that they may not even be aware of (e.g., a “facility” charge, a specialist charge, an imaging charge, as well as other costs hidden until the bill arrives).
This is a problem, and it is a massive one.  But rather harping on “what is wrong with health care”, I prefer to take the high road.  I prefer to highlight solutions—and one was just rolled out earlier today.
I am talking about the Choosing Wisely campaign.  This is as good as it gets, and demonstrates that doctors and the organizations which they belong to want to try to fix some of the costs associated with care.  Specifically, this initiative is looking to focus on the “overuse” in medicine that is so common today. 
There are tests that physicians and other health care professionals order on patients which unfortunately have NOT been proven to improve care.  In fact, sometimes these tests lead to more unnecessary tests, without improving outcomes.  It is the outcomes that matter most.
The American Board of Internal Medicine Foundation (or ABIM Foundation, for short) worked with multiple medical organizations to determine 5 tests within each specialty which should NOT be ordered for common issues pertinent to that organization.  In the first roll out, announced today, 9 specialties each discussed 5 tests which should be avoided in specific, common patient care scenarios.  What a fantastic idea!!
While there may be other potential solutions for lowering the costs of health care, the reality is that it still is physicians and other health care professionals who order these tests.  If they can decrease the ordering of unnecessary tests, costs will be reduced, plain and simple.
This is NOT rationing, in my opinion.  It is simply working smarter to do things which are the right thing to do (or to avoid things which are the wrong thing to do).  It means explaining to patients that a CT scan is not necessary for that headache.  It means not ordering an MRI for that patient with low back pain who likely has a low probability of having a rare condition causing that pain.  A simply way of explaining it is "first do no harm"--what I learned on the first day of medical school is still just as important as every other thing I learned.
Please support this cause.  It is really a noble one, and should and will be promoted throughout medicine, whether it involves patients seen by primary care physicians or those seen by specialists.  What I really like is the approach to roll this out not to just the physicians and medical organizations, but to the lay public as well.  It will also be mentioned in Consumer Reports later this year.
Support the Choosing Wisely cause.  It is an example of physicians choosing to put what is right and what they can do right now to improve health care first, and their own pocketbooks second.  I know that I will put it into practice immediately, especially when seeing patients and teaching medical trainees at the point of care.
For a list of the 45 statements from the 9 organizations, click here