Family Medicine: Innovation and "The Hershey Conversation"

The Dr  Synonymous Show November 2, 2010

Family cheap viagra:  Innovation and "The Hershey Conversation"

Listen on Blog Talk Radio at this link 24/7.

http://Blogtalkradio.com/drsynonymous

Introduction and Welcome

Congratulations to my hometown of Dayton, OH being named the Number One Worst City for Allergy Sufferers in the US.  

ALLERGY FOUNDATION RELEASES ANNUAL REPORT OF 100 “MOST CHALLENGING” U.S. CITIES FOR FALL ALLERGY SUFFERERS

Disclaimer- I am a practicing family physician, but we're not practicing cheap cialis on the show.  Your best way to get good health care is through your personal family physician.

Patient honoring: We're only doctors because there are patients.  Let's always honor them.

Patient Blog:  That's What She Said "Inflammation and My Hippie Ways"

http://snc-thatswhatshesaid.blogspot.com/2010/11/inflammation-and-my-hippie-ways.html



Physician Blog:  Musings of a Distractable Mind by Dr Rob 11/2/10.  Election Reflection.



http://distractible.org/2010/11/02/different-lunatics-same-asylum/

My blog: Surprised at the geography covered by readers. 

The Family Medicine Education Consortium NE Regional Meeting in Hershey, PA

www.fmec.net



The Healthcare Innovators Network- a Pre-conference session

Several speakers with special messages from :

Alan (Chip) Teel, MD Elder Power to help Seniors remain in their homes www.Lincme.net

     started in Damariscotta, ME. High Touch, High Tech Senior Support.

Seven Dollars Can Change Lives by Edward G. Zurad, MD. Improving employee health and saving health dollars.

Patient Broadcast Network by Shawn Moyer, MD of Pinchot Med Center, Pinchot, PA (Small,  successful family practice using OX Bow EMR- unique and family medicine friendly)

http://www.pinchotfamilymed.com/



Co-Ops for Medicine by Cathy A. Smith, Using Farm Concepts to help people survive together- one vote per person.

Patient Centered Medical Home Presentations abounded.  Geisinger Health Center and others.

TV coverage of FMEC Meeting:  Notice the medical students. Emphasis on the pipeline to deliver good family doctors.

http://www.whptv.com/mediacenter/local.aspx?articleID=145699

Challenged kids dance and arts program:  Reach USA with 400 youth involved.  Enthusiastic group danced at FMEC meeting. See photos below

www.site.reachusainc.com

More Reach USA photos

http://www.facebook.com/ajax/share_dialog.php?s=7&appid=2344061033&p[]=105019159550266&action_link=



Other Important Presentations:  Social Media by Kenny Lin, MD; Doctor Anonymous, Dr Synonymous well attended, well received update on various uses for social media in Family Medicine.  PAFP students started a blog, tweeted and used facebook and YouTube at the meeting.



http://www.youtube.com/watch?v=hw0g2g5YkgM&feature=related 

Roland Goertz, MD, MBA President of AAFP "The Time Has Come" A great leadership talk with emphasis on where we're headed.  Special comments for medical students about a career in family medicine.



Coaching for Performance by Anton Kuzel, MD and Will Miller, MD Great leadership session about coaching and leading.



Beyond the PCMH: the Consumer-Oriented Human Centered Health Home (HCHH) by Steve  Deal, MS; Rosemary Ramsey, PhD; and Pat Jonas, MD.  A step in the right direction.





Aligning Primary Care Workforce and Infrastructure in an Era of Reform:  New Data and Online tools from the Robert Graham Center. Important data about primary care workforce from each medical school and residency.

http://www.graham-center.org/online/graham/home.html



Book Signing by authors in attendance:  Behavioral Medicine in Primary Care by Julie Shirmer et al.  The section on physician burnout is compelling. We need to take better care of ourselves.



So many great aspects to FMEC NE Meeting 2010. Overall a highly motivating experience and a breath of fresh air about the future of family medicine and health care.  It seems like we've started "The Hershey Conversation" about hope for health care and for people, like our patients and our selves.



My opinion of FMEC:  Important Organization. Stay tuned.

http://fmec2010.blogspot.com/2010/10/fmec-pat-jonas-md.html

Go to twitter.com and search for #fmecnet  for tweets from the meeting.  Notice the tweets from med students, especially those from the PAFP.

Next week at 8-9 PM Tuesday night on BlogTalk Radio, I'll interview Ken Bertka, MD past president of the Ohio Academy of Family Physicians (OAFP) and recently a Board member of AAFP about family medicine, healthcare reform,etc.

The characteristics of future physicians

In my blog from 2/4/11 "Why do we put so much import on the MCAT?", I discussed some of the negative characteristics that can be associated with a higher MCAT. The conclusion of the article by Dr. Gough¹ was that students with higher MCATS and a scientific orientation were found to "less adept in interpersonal skills, less articulate, narrower in interests, and less adaptable than their fellows". 

Wow!  I don't think those are characteristics that I want in my doctor.  What about you?

What are the characteristics that we want in our medical students? We want them to be great at science, right?  On average, academic performance in undergraduate classes only predicted about 9% of the variance in medical school performance.² What about MCAT? We want them to have a high MCAT, right? Well, a high MCAT is good at predicting performance on the USMLE step 1 and preclinical grades,³ but as someone who is really smart once told me "we are not trying to make step 1 passers".

Sade and colleagues asked this same question a few years ago. Their specific question was to identify the specific characteristics that are important qualities of a superior physician. They also asked which of these qualities are hardest to teach in the medical curriculum. They based their work on a study by Price, et al⁴ who had previously generated a list of positive traits associated with a superior physician.  

Dr. Sade took this list of traits and showed them to the faculty of the College of cheap cialis at the University of South Carolina. The faculty were asked to rate the personal qualities on a scale of 1-10, where 1 is non-teachable and 10 was easily teachable. The survey was sent to all of the faculty at the college of cialis. They also asked a select group of experienced medical educators to take the survey. There was remarkable agreement between the faculty, greater than 80% inter-rater reliability. There was also a high correlation between the basic science faculty's ratings and the clinical faculty's ratings of the importance of characteristics (r=0.87, p<0.001) and the teachability of characteristics (r=0.93, p<0.001). 

The outcome of this survey was a list that ranked the characteristics from 1 to 87.  Each characteristic was given a rank for importance and for difficulty in teaching. The authors converted the rankings to a Z-score. (***Note: This was my favorite line in the manuscript...)  "The teachability Z-score was subtracted from the importance Z-score, and the combined Z-scores were multiplied by 10 and added to 50."  This gave a combined score that they called the NonTeachable-Importance Index (NTII). The NTII gives you a list of characteristics that are ranked from highest to lowest based on importance and the difficulty of teaching it to medical students.

That sounds like a good list of pre-matriculant variables to me.  If we can't easily teach it but it is important then obviously we should select students that have these characteristics before coming to medical school.

Using the NTII ranking, some of the characteristics are obvious: (1) is emotionally stable; (2) is a person of unquestionable integrity; (5) is unusually intelligent; and (6) has sustained genuine concern for patients during their illness.  Some are less obvious but seem really important: (9) is motivated primarily by idealism, compassion, and service; (14) is able and willing to learn from others; (17) is observant; and (18) is adaptable. The list goes on from 1 to 87. 

The characteristic that was ranked as the most difficult to teach was: is unusually intelligent. The next four were: (2) is naturally energetic and enthusiastic; (3) is imaginative and creative; (4) has a warm, friendly, outgoing personality; and (5) is motivated by sheer liking of people.

So why are we still choosing medical students based on the MCATs and GPAs? Maybe, we should be looking at these factors.

Next time, I am going to write about personality factors that influence medical student performance.

References

(1) Gough HG. Some Predictive Implications of Premedical Scientific Competence and Preferences. J Med Educ  1978; 53: 291-300.

(2) Ferguson E, James D, Madeley L. Factors associated with success in medical school: systematic review of the literature. BMJ  2002; 324: 952–7.

(3) Donnon T, Paolucci EO, Violato C. The predictive validity of the MCAT for medical school performance and medical board licensing examinations: a meta-analysis of the published research. Acad Med  2007; 82(1): 100-6.

(4) Price PB, et al. Measurement and predictors of physician performance: two decades of intermittently sustained research. Salt Lake City: Aaron Press, 1971; 121-149.

Hospital visitation and health care decisionmaking autonomy for EVERYONE

Wisconsin may be poised to go down the same road Maryland choose last year -- the conflation of recognition of same-sex couples with the needs all people have, especially LGBT people estranged from their families of origin, to purchase cialis visits from loved ones and medical decisionmaking by the person who knows them best. (Even Obama got it wrong in his acceptance speech). And Wisconsin is actually getting it worse; they are making couples register as domestic partners to get rights that all human beings deserve.

It seems that whenever a state passes anything with the phrase "domestic partners" for same-sex couples, that's supposed to count as a gay rights win. But look at what Wisconsin actually plans to do. The couple must be same-sex only and must live together. If they register, then they can visit each other in the cialis and make medical decisions for each other.

What is wrong with this picture? Ask my 60+ year old friend in Maryland, who is single yet cares as passionately as her coupled friends about who gets to visit her and make health decisions if she can't. And she's not even estranged from her closest living relative -- a sister 2500 miles away. Think about the gay people who move to gay-friendly areas, away from families of origin. I care that the people they consider family be able to visit them in the hospital. I care that their wishes about a surrogate health-care decisionmaker be upheld.

There ARE answers. A free, easy to use, highly publicized advance directive registry. There are models in gay-unfriendly states, like Idaho, and they protect everyone. How about a law that requires hospitals to ask who you want to visit when you've admitted? It won't help emergency admissions. But the people listed in the advance directive registry should be admitted. And a "close friend" category would help, and I didn't make up that category. Many surrogate health care decision making statutes already list "close friends" among those who can make decisions. At least when no one else is at the hospital, when a person will be without visitors, "close friends" should be allowed.

I hate to put a damper on the celebrations in Wisconsin. I just think it's wrong to conflate recognition of same-sex couples with the basic human right to health care decisionmaking by the person we choose and the chance to be surrounded by loved ones in our darkest hours.