Health Education Reform?

In my first year of med school, a preceptor asked a small group of us, "From what part of a patient encounter do you get the most information - the history, the physical exam, or the lab tests?" Almost everyone said lab tests. I went out on a limb and said physical exam. The answer, obvious to most physicians in practice, is the history. Studies have quantified this.

If a group of people who had managed to get into medical school didn't know this, does the general public know that the most important part of many of their medical encounters is the part at the beginning when they are asked a bunch of questions? So if you come in with pain, we want to know when it started, where it is located, how long episodes last, the quality and severity of type of pain, what other symptoms are associated with it, what makes it better, what makes it worse, what have you tried for it, etc. Often we have a pretty good idea of what is happening just based on that. There are a number of acronyms for these bits of info and they have to be documented for a physician to get paid.

So then I am thinking back to Health Education class. I learned about nutrition, exercise, sex ed, etc. But I never learned how to talk to a doctor. Or more precisely, how to communicate information to a doctor in a somewhat coherent manner. We do that in elementary school English - main idea, topic sentences, etc. But if we teach students to organize their paragraphs, why can't we teach them to organize their symptoms? Is there a "garbage in, garbage out" component to our health care woes that we should think about?

So how about we have some joint English and Health classes to learn how to present our medical complaint information as effectively as possible so doctors don't have to waste precious time interrogating it out of us (or giving up and ordering the test)? And how about some joint Health and Math classes so we all learn that our fancy, expensive tests have many, many limitations - such as false positives - especially, when we use them indiscriminately. Are the concepts of sensitivity and specificity any harder to teach than, say, algebra?

And heck, maybe this doesn't need to be a political football. Maybe education that teaches personal medical encounter responsibility can unify progressive and conservative alike?

Give Me Twitter or Give Me Death

So I am wondering if Twitter can be used in Iran to organize election protests in a texting blackout, why can't a similar tool be used for communication between health care professionals in the haze of everyday medicine?

A quick search of the internets reveals that a blogger named Phil Bauman envisions 140 health care uses for Twitter.

Pretty compelling. Maybe Personal Health Records could one day contain a secure twitter-like capability and Phil's vision could become reality.

Best Telemedicine Screenplay

Ok, maybe the re-enactment in this video is a bit corny, but the potential of the technology highlighted is, if anything, understated.

iFood Diary?

How come we don't have cool stuff like this in the US?

In Japan, McDonald’s customers can already point their cellphones at the wrapping on their hamburgers and get nutrition information on their screens.

Imagine if our cell phones had programs that kept a running total of calories, carbs, fat, etc. Maybe when contemplating the consumption of a piece of cake, we could point our cell phone at its bar code and then decide. Maybe more of us would stick to our diets. Or at least maybe more of us would know if we are sticking to our diets!

Money, Money, Money

The New York Times editorializes:

Doctors largely decide what medical or surgical treatments are needed, whether it will be delivered in a hospital, what tests will be performed, and what drugs will be prescribed or medical devices implanted.

There is disturbing evidence that many do a lot more than is medically useful — and often reap financial benefits from over-treating their patients. No doubt a vast majority of doctors strive to do the best for their patients. But many are influenced by fee-for-service financial incentives and some are unabashed profiteers.

Maybe it would help if we promoted medical education pathways which reduce the average $139,517 of debt borne by graduating US Medical Students. Perhaps Creighton University's School of Nursing is on to something, promoting nursing as a pre-med major.

After completing such a program, one could work for a couple years to pay off undergraduate debt. Medical schools could create work-study programs. Nurses are in shortage, after all.

There's got to be a way to avoid the sense of poverty many physicians feel in the early stages of training. A little thought to this problem could go a long way.

Opposite Day

Why should a conservative support universal health care?
Because trapped somewhere in middle management is a person with an idea that will create wealth and jobs. But that person is too scared to start a business because a dependent has a pre-existing condition.

Why should a progressive fear universal health care?
Mission accomplished may be declared far too soon while entrenched health disparities persist.