March 07, 2013
Specialists vs. generalists
Quote of the day by Jeremy Hill:
"Teaching by specialists is fraught with difficulties on a family medicine course: although they may be experts in their own field, many specialists may never in their careers have had exposure to family medicine. So it is difficult for them to appreciate that family doctors deal primarily with patients and their symptoms rather than with diseases. The gulf between what is taught and what needs to be learned seems difficult to bridge."
Residents and Med Students have different needs
Don't overwhelm the med students by teaching them alongside residents. There is a qualitative difference in what and how they need to learn.
Electronic Health Records
When I was at Iowa about 10 years ago, I couldn't believe the medical records system. Every patient had a spiral-bound gold folder, and undergrads would push metal carts piled high with them around the hospital. It seemed so silly that I could access any academic journal article I wanted from any computer at the University (or even at home!) but doctors had to wait wobbly wheely carts to make way through halls and elevators.
And it was silly. Time was being wasted, mistakes were being made, information was no doubt lost (I have no evidence it was). So people are working to make these things work better. But change always brings pushback, and change always brings unexpected complications and inefficiencies. And the conservative folk who opposed the change always have a valid argument that it was a bad idea, even if the change is mostly for the better.
This last year I've watched Michigan adopt a new electronic records system called MiChart, and I've heard nothing but grumbles. I watched our own family physician, talking smooth doc-talk to my wife's complaint of a sore throat, slowly turn to a mumbling grump because he couldn't find the right pull-down menu on the user interface to just order the damn strep test.
I assume as people grow into a EHR system, they with bristle. Every new software is confusing and ugly and irritating. And certainly the federal government's push to get everyone on compatible EHR systems makes it feel worse.
What I can't assume is that EHRs will prove better than pushing carts of paper around. But they have to, right? Mayo's been doing EHRs for a while now, and managing good records is pretty much what made them famous: efficient information facilitates good care.
Anyhow, I found this article in my news feed and it got me thinking about this again. Students are being trained in an EHR setting and will no doubt be more comfortable with this stuff than my paper-head family physician will ever be.
March 05, 2013
Knowledge vs. know-how
The heady stuff of medicine---the diagnosis, the treatment decisions, the patient interactions---are dramatic enough for TV. But apparently the technical things about how things are done are not.
There's a lesson in here somewhere.