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