Today’s New Yorker has a story, Personal Best, by Atul Gawande. It’s about coaching, and the seemingly novel idea that doctors might engage coaches – individuals with relevant expertise and experience — to help them improve their usual work, i.e. how they practice medicine.
Dr. Gawande is a surgeon, now of eight years according to his article. His specialty is endocrine surgery – when he operates it’s most often on problematic glands like the thyroid, parathyroid or appendix. Results, and complications, are tracked. For a while after he completed his training he got better and better, in comparison to nation stats, by his accounting. And then things leveled off.
The surgeon-writer considered how coaches can help individuals get better at whatever they do, like playing a sport or singing. He writes:
The coaching model is different from the traditional conception of pedagogy, where there’s a presumption that, after a certain
See more Do Doctors Need Coaches? Atul Gawande Considers How Physicians Keep On Learning
Today I visited my internist for a checkup and flu shot. We talked about how I’m doing, and she examined me, and we discussed what procedures I ought have done and not done. She’s been my doctor since the summer of 1987, when I was an intern at the hospital.
We reviewed so much that has happened in the interim.
How rare it is, now, to have a doctor who knows me. Continuity in care is so valuable.
One of my greatest fears is being in the hospital again, and having hospitalists – doctors who work full-time in the hospital – be the ones to see me each day, and make decisions about what I need. Yet I’m bracing for it because, well, that’s how it is, now.
From a health care administration perspective, I recognize the value of delegating inpatient care to physicians who are not my usual doctors.
See more The Immeasurable Value of Continuity of Care
Recently the NEJM ran a Sounding Board piece on Bending the Cost Curve in Cancer Care. The authors take on this problem:
Annual direct costs for cancer care are projected to rise — from $104 billion in 20061 to over $173 billion in 2020 and beyond.2…Medical oncologists directly or indirectly control or influence the majority of cancer care costs, including the use and choice of drugs, the types of supportive care, the frequency of imaging, and the number and extent of hospitalizations…
The article responds, in part, to Dr. Howard Brody’s 2010 proposal that each medical specialty society find five ways to reduce waste in health care. The authors, from the Divisions of Hematology-Oncology and Palliative Care at Virginia Commonwealth University in Richmond VA, offer two lists:
Suggested Changes in Oncologists’ Behavior (from the paper, verbatim — Table 1):
1. Target surveillance testing or imaging to situations in which a
See more Running 2 Lists That Might Lessen the Costs of Oncology Care
Forbes kept a close eye on the annual ASCO meeting in Chicago. On THE MEDICINE SHOW, Forbes’ Matthew Herper provides a précis of a speech by outgoing ASCO President Dr. George Sledge.
Here are my two favorite parts:
“So what happens when, a few years from now, a patient walks into a doctor’s office and hands a physician a memory stick loaded with gigabytes of personal genomic data?” Sledge asks. His answer: the flood of data will help doctors and patients, but things will get “very, very complicated.”
…Doctors will need real-time access to clinical data from all practice settings. This in turn will require interoperable databases using common terminology. Health information technology should offer on-the-spot decision support to oncologists and patients facing the increasingly complex tapestry revealed by modern genomics. It should provide individualized, ready access to a clinical trials systems. It should support appropriate coverage and reimbursement
See more Quotes on Oncology, Via Forbes, and a Spiraling Helix
Yesterday I wrote on some tough decisions facing a TV show’s protagonist. She’s got metastatic melanoma and might participate in a clinical trial when the show resumes.
Now imagine you’re an oncologist, or a real patient with this killing disease — you really need to be on top of new developments, to understand the pros and cons, because someone’s life depends on it.
If you’re the doctor in the relationship, you need keep abreast of current information for all the other tumors types of patients in your care: what are the new findings, if any, what are the limitations of the data. You need to know how the advances apply to an individual person who, most likely, has another condition or two, like high blood pressure or, say, osteoporosis.
Oncologists ought to be familiar with new drugs, and how those compare to old ones, and the side effects, and the
See more TV Meets Real Life Oncology, and Anticipating the MCATs
The author learned a new word this weekend while attending the annual meeting of the Association of Health Care Journalists in Philadelphia.
In a richly-informative session on ethics of clinical trials, one of the speakers, Dr. Jason Karlawish — a bioethicist, geriatrician and Alzheimer’s researcher at the University of Pennsylvania, taught me a new term: theranostic (alt. spelling: theragnostic).
The neologism calculatingly brings together the concepts of medical therapy and diagnosis. This goes beyond biomarkers, he explained; theranostics are novel tests or diagnostic markers that would identify patients who, as defined, benefit from a particular therapy.
The first international conference on theranostics will be held in June, he told the audience.
Related Posts:News on Niaspan, Cholesterol Drugs and BiomarkersReview: Dr. Eric Topol’s Creative Destruction of MedicineNIH Sponsors New Website to Help Patients Understand Clinical TrialsNEJM Reports on 2 New Drugs for Hepatitis CWhat is the Disease Control Rate in Oncology?
An article in the March 24 NEJM called Specialization, Subspecialization, and Subsubspecialization in Internal Medicine might have some heads shaking: Isn’t there a shortage of primary care physicians? The sounding-board piece considers the recent decision of the American Board of Internal Medicine to issue certificates in two new fields: (1) hospice and palliative care and (2) advanced heart failure and plans in-the-works for official credentialing in other, relatively narrow fields like addiction and obesity.
The essay caught my attention because I do think it’s true that we need more well-trained specialists
See more In Defense of Primary Care, and of Sub-Sub-Sub-Specialists
The Times ran an intriguing experiment on its Well blog yesterday: a medical problem-solving contest. The challenge, based on the story of a real girl who lives near Philadelphia, drew 1379 posted comments and closed this morning with publication of the answer.
Dr. Lisa Sanders, who moderated the piece, says today that the first submitted correct response came from a California physician; the second came from a Minnesota woman who is not a physician. Evidently she recognized the condition’s manifestations from her experience working with people who have it.
The public contest – and even the concept of using the word “contest” – to solve a real person’s medical condition interests me a lot. This kind of puzzle is, as far as I know, unprecedented apart from the somewhat removed domains of doctors’ journals and on-line platforms intended for physicians, medical school problem-based learning cases, clinical pathological conferences (CPC’s) and
See more Crowd-Sourcing a Medical Puzzle
This morning I toured Google’s new Body Browser. The trip wasn’t as easy as I’d envisioned; I got sidetracked on my way, having to update my Web browser before entering. The site requires an advanced Web browser, like Chrome beta or Firefox 4.0, to accommodate 3-D graphics.
Update accomplished, I forged into Google-woman’s frame. (There is no man available, as yet.)
See more First Inspection of Google’s Anatomy
The cover of the November print edition of Wired features large, unnatural-appearing cleavage. Inside and toward the back of the issue, a curious article ties together stem cells and the future of breast reconstruction. It got my attention.
Wired, November 2010 issue
The detailed and admittedly interesting piece, by Sharon Begley, describes what’s science or science fiction: first humans, such as some plastic surgeons, remove adipose tissue, a.k.a. fat, by a well-established cosmetic surgery procedure called liposuction, from a body part where there’s a fat surplus — such as the belly or backside; next, laboratory workers purify and grow what are said to be stem cells from that that fat; finally, they use a nifty, calibrated and expensive device to inject those fatty stem cells where women want, such as in a hole or dimpled breast where a tumor’s been removed.
The story starts, unfortunately and distractingly, with a
See more Stem Cells, Breast Reconstruction and a Magazine Cover
As Sue, a woman who’s had breast cancer told me last month: “You don’t want a radiologist who’s just looked at someone’s broken foot examining your mammogram.” She’s right. Expertise can make a huge difference in clinical outcomes.
See more Five Ways to Improve the Quality and Success of Breast Cancer Screening by Mammography
What is comparative effectiveness research and why does it matter? The idea, basically, is to inform medical decisions with relevant data derived from well-designed clinical trials. This sort of research will provide the foundation for evidence-based medicine (EBM).
See more News, and Thoughts, on Comparative Effectiveness Research
“This caught my interest because it doesn’t diminish physicians’ autonomy,” Blumenthal said. It just enables them to make decisions for their patients in the context of additional, current information. “The end goal is not to adopt technology, but to improve care.“
See more No More Clipboards
So while this little debate might seem minor and technical, reflecting some pettiness and distinct personalities among the various physician-bloggers, it bears on a serious issue for medicine, which is not so easily resolved: what are the tasks that we really want doctors to do, and not to delegate. This discussion relates to a recent editorial in the New York Times on whether we really need physicians to administer anesthesia…It bears also on simpler matters — whether doctors should spend time calling patients themselves about routine test results, adjust coumadin and other drug doses …
See more Big Implications of Blog-Bickering About What Doctors Should Be Doing
There’s been a recent barrage of med-blog posts on the unhappy relationship between doctors and electronic communications. The first, a mainly reasonable rant by Dr. Wes* dated August 7, When The Doctor’s Always In, considers email in the context of unbounded pressure on physicians to avail themselves to their patients 24⁄7. That piece triggered at least two prompt reactions: Distractible Dr. Rob’s** essay on Why I Don’t Accept eMail From Patients and 33 Charts’ Dr. V on The Boundaries of Physicians Availability.
Perhaps the most astonishing aspect of these three guys’ essays is that, in 2010, there’s still a question about whether doctors should use email to communicate with patients. It’s hard for me to imagine physicians – including bloggers — so disconnected. But many are.
Last year, I had the opportunity to speak with Professor Nathan Ensmenger, a historian of technology at the University of Pennsylvania who’s studied physicians’
See more Doctors Not Using Email Like It’s 2010