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Where We Begin

By Emily Lu

Something I’ve learned about the medical profession from my first year in it: we want to know and do everything. Despite all the warnings from our professors and the pass-fail system, we pore over lectures, textbooks and review books to “at least have seen” every detail. My professors faced with the changing landscape of health care seem to reflect the same desire with a “new curriculum” that includes topics such as health policy, social disparities and ethics (classes which, on the whole, I find very worthwhile, but that’s another story). Such a curriculum is shaped a little differently at each medical school, but they all propagate the same notion that in this day and age, doctors must be conversant in the whole spectrum of social and political factors affected by medicine. We must not only be physicians but also social workers and advocates, cost-conscious and patient-centered, all at once.

Along with all the talk of multidisciplinary learning, there is also the sense that doctors must triage, that we should be moving towards more team-based care, that the future of medicine will see the role of the MD being fundamentally different than it is now. Yet, what that future looks like is still very unclear, even to policy-savvy docs on the frontlines.

Runner starting a raceRecently, I attended a pre-conference discussion on transitions of care for young adults with special health care needs. The audience included pediatricians, internists, nurses, other health care professionals and a couple other medical students. The discussion focused on practical tools that physicians could use at the visit for gauging patient health literacy and portable health care summaries for assisting in patient communication with their other specialists and doctors. The questions in the audience focused on practical issues: how to schedule separate appointments to go over their portable health care summaries, at what age should pediatricians begin to discuss transitioning to an adult provider, etc. Only a couple questions addressed whether there was any better way of doing things: one asked generally whether the group leading the training was involved in political advocacy (they were) and the other wondered whether we should instead be transferring such patients to specialized med-peds practices (the supply of suitable med-peds doctors was deemed too low).

We dream of patient-centered medical homes – perhaps your clinic is even in the process of implementing one. We talk about nurse care mangers and patient navigators – perhaps your clinic even has one or refers to such a service. Nevertheless, in actual discussions of how we address patient issues now, the ultimate responsibility seems to still fall upon the doctor to try and figure out how to fit everything into the twenty minute visit.

Are we still so cynical to not truly believe that change is coming? Or is this more deeply rooted in our tendency to place the doctor-patient relationship at the center of all health care? There are justifiable reasons for why we might want to say “yes” to both of these questions: change is slow, resources are limited, and no matter what changes are made the doctor-patient relationship is still very important. However, if we are to move forward into the future of health care, we need to all acknowledge our biases and understand how they shape our discussions of what health care will and should look like.

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