Medicine is a Service Profession: Leveraging Patient Knowledge

Drs. Kesselheim and Cassel published a perspective piece in the NEJM “Service: An Essential Component of Graduate Medical Education”. Here is the link to the article abstract. Sorry it’s behind the pay wall. L

In my mind the first sentence ties to social media and current patient behavior to healthcare while defining service, “Medicine is a service profession, and commitment to service is a hallmark of humanistic physicians.”

First, the primary point the authors make is that Accreditation Council for Graduate Medical Education (ACGME), (which provides oversight for residency programs) recently completed a survey that asked about evidence of excessive scut work. ACGME framed the question “How often has your clinical education been comprised by excessive service obligations?” Service is completing a chart, dictating a letter and revising, entering orders in a chart, etc. The authors present a cogent argument that the ACGME question asks residents to give personal interpretations of what service is and what education is when in fact service is part and parcel of education. Service is not counter to education.  Service is key to graduate medical education as witnessed by practicing physicians. They know from their years of practice that service is an important teaching tool because it is more likely that ‘scut work’ is solving problems. Solving those problems creates reflection, which is how humans learn. This optimizes resident and physician education with patients.

In a larger context of what is happening with patients today online, and in social media (SM) behavior service has a direct and valuable connection to what it means to be a “humanistic physician”. As we know, more and more patients and caregivers are using the Internet to learn about health, healthcare, and disease specific knowledge. They are becoming advocates for their health for themselves with their healthcare professional (HCP). They are asking questions, making HC decisions, and are pushing the boundaries of HCP and patient interaction. As that old troupe says “Enquiring minds want to know.”

I can’t think of anything that witness’s the power of service and humanistic behavior more then the HCP helping patients become more knowledgeable in managing their own healthcare. Service is not just tending to the clinical issues of a patient but improving the knowledge of those enquiring minds. What can we do to drive the person seeking information about their healthcare and change information into knowledge? Have the HPC provide it and help to make make it part of improved patient behavior.

The HCP cannot be part of this change without accepting and embracing service on what some consider a horrific level, patients asking annoying questions and making requests. So as the authors argue it is key that we don’t paint physician service ‘scut work’ with a wide tar laden brush as non-education but put knowledge and learning into a bidirectional service driving outcomes beyond the dx and script. We know that patients who are involved in their healthcare with their HCP use less physician time and have better outcomes. it is knowledge and sharing this service I call knowledge transfer that drives this change.

The world is changing and HCP needs to change as well and must accept a new vocabulary where service is not scut work but learning. Where the HCP is driving knowledge and not treating it like dollops of sour cream on a baked potato. We are seeing it work on sites such as Howard Luks, MD, his Twitter timeline and more. Howard and thousands of others are taking service and making it learning driven and this is the brave new digital world.

My final thought on this comes back to my general attitude toward healthcare and learning. Just because you create a web site, have a Twitter account, or post on Google + it does not mean you have a set of goals/objectives or a strategy (see this on strategy) to service your patients and improve their knowledge. 

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