Imagine the possibilities

Do you ever wake up in the middle of the night with your mind racing and you’re unable to go to sleep? That happened to me last night after falling asleep and missing out on some much-needed entertainment. I woke up thinking about how the medical culture makes student doctors (better known as medical students) learn medicine and it occurred to me that maybe we’ve got it wrong.

Maybe we’re holding back progress from Day 1.

Maybe we’re serving the interests of tradition and not the interests of progress.

Maybe there’s a better way.

Think about the last time you needed to know something. For example, let’s say you were going to buy something on Amazon.com. Now, that product may be cheaper elsewhere and it may not be so what do you do? More than likely, you check a price summary website like pricewatch.com or you check your other favorite sites before ordering.

Now apply that to a hospital setting. The doctor is “pimping” the medical student for information and the student may or may not know the answer. Traditionally, the student will either be rewarded for knowing the answer to a random question or will be met with mild disapproval or ridicule for not knowing the 3rd step of the WHO clinical treatment guidelines for chronic flatulence. The physician will then likely provide the answer and move on with the case.

Stop. What are the problems with this scenario? How can the training interaction between the doctor and student be improved? What steps can be taken to improve the ultimate goals of patient care?

Now contrast it to this scenario. The same question is posed and our intrepid medical student doesn’t know the answer thus being met with mild disappointment. However, using the wonders of current database and integrative technology, our hero rapidly refers to the treatment guideline and, combined with his/her knowledge of medicine, is able to provide an answer to the pimping physician. The student has now not only learned real-time integration of new information but he/she has also learned clinical self-reliance, an important step in becoming an excellent solo practitioner. The supervising physician can then tweak the student’s response where necessary and further contribute to the patient care learning process (who knows, the student may even prevent the supervising physician from making a mistake). The final piece of the puzzle is now in place: clinical teamwork. This experience is then carried forward with the student learning to, when needed, integrate the PDA data device into clinical decision and share resulting treatment ideas to reduce errors and improve quality.

Errors which, by the way, contribute to the preventable death of ~195,000 Americans per year (as estimated by HealthGrades), injure an additional 1.5 million Americans and conservatively cost $3.5 billion a year not accounting for lost wages, productivity or additional health care costs. Studies also indicate that 400,000 preventable drug-related injuries occur each year in hospitals.  Another 800,000 occur in long-term care settings, and roughly 530,000 occur just among Medicare recipients in outpatient clinics.  The Institute of Medicine Board on Health Care Services Committee on Identifying and Preventing Medication Errors noted that these are all likely underestimates. (http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11623)

Ron Zook, former coach of the Florida Gators, said that you learn more from failure than you do from success. Ron Zook was also fired after a few seasons. Let’s not follow Zook’s logic.

Some progressive schools like Florida State University are beginning this approach to bedside-integrated technological medicine and it should be expanded as rapidly as possible. This is the 21st century with an exponential increase in knowledge, technology and information access. We have to be willing to think creatively and integrate innovations if we’re going to do the best for our patients.

So for me, I’ll keep using my iPhone, Epocrates and Neph Calc as I learn clinical medicine. I’ve never been one to be stuck on tradition.

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