For many years, I taught a sizable chunk of our local medical school’s second-year pathology course. I was always energized by the students’ enthusiasm and desire to learn more about medicine. On the other hand, I remembered feeling their same frustrations regarding the lack of fundamental practice skills included in today’s medical school curriculum.
In fact, at our university, a group of students started a business in medicine interest group, where the following charge: “We attempt to cover topics not presented in the medical school curriculum that are necessary for the business operations of our health care systems. Ultimately, we strive to provide a solid foundational overview in order to increase our comfort level before residency begins.”
As I prepare to talk to them today, here are four things we should be teaching our future health care practitioners.
1. The current financial state of U.S. health care. What other industry sends highly-trained professionals into the workforce with no financial context in which to practice?
The U.S. health care system is in financial trouble. No one can argue that. By 2025, it is projected that entitlements and interest will eclipse all tax revenue. That can’t be good. Physicians can’t sit back and watch health care costs surge. We have to address utilization and waste for ourselves before the government does it for us.
2. There is tremendous variation in how we practice medicine. Appropriately used clinical protocols are not evil. They are not “cookbook” medicine. Call them whatever you want, when designed and implemented properly, protocols save patients’ lives. Standardization of the steps in routine patient care that do not utilize physician intellect frees up time for us to focus on actually practicing medicine. If everyone has a different way to treat a disease process, we can’t all be doing it the best way, right?
3. Quality controls cost. I’ve been told that when you talk to physicians about the relationship between quality and cost, never lead with cost. The perception is that financial stewardship has become a dirty word in medicine.
I have a high-deductible health insurance plan, and I really appreciate it when my doctor takes drug costs into account. Is that so bad? Can’t we apply this to all types of cost that plague our health care system?
Yes, in general as quality goes up in health care, costs do go down. If you go to a “high cost” hospital, it has been shown that quality is usually worse. Let’s de-stigmatize the importance of the physician’s role in controlling the finances of health care.
4. It’s impossible to keep up. More than 700,000 references were added to PubMed in 2013. In order to maintain current knowledge, a general internist would need to read 20 journal articles per day, 365 days a year. On top of that, the vast majority of what we practice has no scientific basis.
It’s OK to admit that we need help navigating the complexity of today’s health care information overload. This is another area where protocols can be very helpful. Once in place, an organized system for regular review of practice protocols can help keep the care we provide up to date. Monitoring our own outcomes can enhance effectiveness as well.
We can’t keep up anymore by relying on subjective recall and saying, “in my experience.”
Alexandra S. Brown is associate director, Healthcare Delivery Institute, HORNE LLP.
