Sunday, 20 July 2014

guides for new docs- what does it say about the culture of medicine?

The BMJ guide for newly qualified doctors is well written and packed with useful information.
It can be downloaded at http://doc2doc.bmj.com/assets/secure/youwillsurvive.pdf
However, if we step back and take a more panoramic view, does it tell us something more interesting about the culture of medicine and the values that it represents?
The guide it titled 'You will Survive', and page 2 starts with the sentence "The first day will always be frightening says junior doctor......."
The overall tone of the guide is that new doctors are going to feel out of their depth and under great levels of stress. The interesting question is to what degree the tone of the guide reinforces the notion that feeling overwhelmed should be considered normal. Preparing doctors to accept that being stressed is the norm and that feeling terrified is acceptable makes it less likely that they will ever question whether healthcare can be delivered in a radically different way.
It's obvious that guide is useful, but does it get the individuals to focus on themselves rather than the system they inhabit?

Thursday, 3 July 2014

What kind of doctors have difficulty asking for help?

Doctors who male, older or suffering from addictions have greater difficulties when asking for help from a Physicians’ Health Program. Very interesting study from a team from Barcelona. 
http://bmjopen.bmj.com/content/4/7/e005248.full.pdf+html

Tuesday, 20 May 2014

Greater professional empathy leads to higher agreement about decisions made in the consultation

Interesting study about empathy in the consultation process.  See the article at http://www.sciencedirect.com/science/article/pii/S0738399114001827
In the study, empathic responses to statements of challenge were found to be a strong predictor of agreement and resulted in both parties reporting and agreeing on more decisions. 
In particular, I liked the fact that empathy can be communicated by simply acknowledging the other. 

Monday, 5 May 2014

The inevitability of physician burnout: Implications for interventions

For physicians, burnout is the inevitable consequence of the way that medical education is organised and the subsequent maladaptive behaviours that are reinforced in healthcare organisations via the hidden curriculum. Thus, burnout is an important indicator of how the organisation itself is functioning. I have written a paper about the issue;
http://www.sciencedirect.com/science/article/pii/S2213058614000084
A central theme of paper is the degree to which the organisational systems are responsible for the disconnect between performance and physician health. Healthcare pays considerable ‘lip-service’ to systems approaches, but in practice it valorises the role of the individual physician in terms of both success and failure. Thus, this contradiction needs to be addressed.

Tuesday, 17 September 2013

Duty hours of residents don’t seem to make a systematic difference!!

It’s hard not reach this conclusion after reading the 2011 review concerning Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules [J Gen Intern Med 26(8):907–19]. The authors warn us about comparing apples with oranges but the lack of any overall pattern regarding the impact on patients and residents is striking. For example, medical and surgical complications were interesting, with some improving and others worsening. The authors try to explain such differences as a product of less exhausted residents or worse continuity of care etc...As noted by the authors, the greatest limitation of the review is that conclusions rest upon studies demonstrating association, not causality. The authors collate a considerable amount of information, but the review (as acknowledged by the authors) doesn’t succeed in communicating the context. 

GPs decision making

A BMJ Open paper [BMJ Open 2013;3:e002982. doi:10.1136/bmjopen-2013-002982] evaluated compliance on treatment recommendations from clinical practice guidelines in their decisions on the management of heart failure patients. This was a vignette study with 451 Dutch GPs (but statistical power was weakened by low number of doctors that followed the recommendations). Maybe the most interesting results were; the fact that none of the 451 GPs took the four optimal decisions presented and that none of the relevant doctor characteristics was related to doctor compliance with clinical practice guidelines recommendations on all four treatment decisions. Obviously something else is at work here, but what?

Thursday, 12 September 2013

What is the purpose of medical education?

There is an engaging article in the recent issue of medical education [MEDICAL EDUCATION 2013; 47: 942–949]. It’s actually an email dialogue between  Dr David Hirsh and Professor Paul Worley. They attempt to address three important questions; Who are medical schools for? What is medical education for? What is the telos (the ultimate aim) of medical education? There is a lot of rich material in the exchange and I can’t do it proper justice here, but I will select out the elements that I liked best:
1.    The goals and purpose of medical education should be community engaged. Thus, communities should be co-creators of the curriculum and its delivery.
2.    There is a need to move beyond student-centeredness in medical education.
3.    The article highlights Cuba and the Barrio Adentro programme in Venezuela as exemplars of community engagement, and suggests that such models could fuel discovery and innovation.
4.    The final line of the paper is quotable; “The systemic result is that the goal of transforming medical education to repair society may actually transform us!”
These are just four parts that I liked; the paper is definitely worth a read. It’s rare that we see a paper exploring the values needed in medical education