Docnotes

Thinking Beyond Health 1.0

"Listen to what the young ones are doing/thinking" is often the guidance of "Innovation Gurus."  Facebook started with them college kids.  Teens texted enthusiastically well before The Rest of Us.

So I went and did my occasional "Medical Informatics" class this morning with the 3rd year students at Albany Med,  and I was surprised by how their education has caused them to think so inside the box.

I recounted Eva Powell's testimony at yesterday's hearing in DC.  Eva had "pink eye" and recounted a several-hours process of getting to the physician, getting a quick look ("yep - that's what it is") and leaving with a prescription.  She asked why a cell-phone camera click .. a short review or conversation with the doc - and an e-prescription couldn't be a more efficient method of managing this problem.

Well of course it could.  Yes, yes .. I hear you doctor scaredypants ..  there are nuances to the diagnosis of pink eye - and the differentiation between viral, allergic and bacterial causes may or may not be so easy on the phone or FaceTime but let's not worry about the details here...   The question Eva appropriately asks is "WHY IS THE HEALTHCARE SYSTEM SO SYSTEM-CENTRIC?"  (ok .. she didn't shout) and she is right.  It's easier for the physician to sit in the office and have patients come to us .. and of course the reimbursment models motivate us to "bring patients in" rather than consider ways to behave in a more patient-centric way.

To me - this is all self-evident.   We SHOULD think outside of our box, work to define new models of care that meet them where they live .. and (duh) use technology to bridge the gap.  

I had breakfast yesterday morning with e-patientDave and he asked me if I had heard of "Shared Decision-Making."  Dave is a wonderful guy - and a great spokesperson for patient-centered care .. and he does a fantastic job of asking the "dumb questions" that we all forget to ask sometimes.  "Yes" - I calmly replied (letting him make his point) .. as I thought to myself .. "DUDE! .. SDM is the CORE of Family Medicine Education! .. It's the CORE of what I believe to be RIGHT about how many providers work with our patients ..  and I've blogged about it for TEN YEARS!

[Fact-check: It looks like my first post here on the topic was nine years ago.  oops].  

So I agree with Dave that we need more shared decision-making .. and I agree with Eva that we need to behave generally in a more patient-centered way.

And so I was surprised when our medical students thought about all of the reasons NOT to help Eva get the care she needed without driving about Washington DC.  They defended the status quo:

"liability"

"risk of wrong diagnosis"

"I need to see them in the office in order to get paid"

"I need to see them in the office in order to write a prescription"

 ... and so on.

I galloped across the front of the room and asked what they heard.  "a Zebra" said one.  

He was almost kidding.

These folks have learned to fear the zebras .. and behave accordingly.  

So over the course of the next fifity minutes .. we talked about the possibilities.  

What if ... computers could do X to help the patients? What if everyone coudl practice like Dave & Barbara?

What if ... 

And they started to stop thinking like carbon copies of the white-coated educators who have been "teaching" them for the past three years - and more like the TwentySomething iPhone-carrying creative Thinkers that they are.

They have an assignment to think outside the box for the next few weeks and draw a picture of what they see.   I'll update you on what happens.  

Where does good come from?

Dr Wilson is in the news again.  I've always been drawn to his work.   My Division I work at Hampshire College in 1983 was on social spiders - and I found that E.O. Wilson had done much of the research on the subject - despite his "claim to fame" in the domain of ants.

Spiders have a reputation for being a solitary lot - and some female spiders eat their mates after they are "finished."  Yet other spiders like each other - and for some reason - as a reasonably solitary college student in 1983 - I was drawn to this work.  

Now Wilson questions some theories that he supported for decades - and he's creating a big stink - alienating many of his former colleagues.  

But to me - his stuff just makes sense (again).  The base of the argument seems to be that the prevailing theories (with mathematical "proofs" that are waay over my head) support species' (including humans') predilection to do good things for relatives - even if it means self-sacrifice - but not for those with whom we are unrelated.

Wilson's current argument is that we needn't be related to form a group with whom we compete with other groups .. and we will "do good" for OUR group - even if it's not comprised of our kin.

I don't get why that's so controversial.  I've not read the science here - and I am sure that there is a pile of data from ants and monkeys and turtles that support this hypothesis.  But there's a lot to reflect on human history where these theories are borne out as well.

As I look at health care - both in the US and elsewhere - much of what defines the most successful people is the right balance of selflessness and self preservation:  we need to think and act beyond ourselves - and focus on the needs of the population - yet if we think TOO selflessly - our efforts are not sustainable.

Kin are convenience groups - since we have good connections with them - for a very long time.  But I would agree with Wilson that IN ADDITION TO (not instead of) our kin - we can/should/do perform "good" acts for others for the sake of being good.  This is not about "getting something back" - and now there is at least one famous biologist who thinks there is a scientific basis for such actions.  

Amid the resurgence of Ayn Rand - and her nutty philosophy - I'd prefer to think of humans as inherently generous.