Community Medicine – Total Health – Dialogue with and from the future at Penn State Hershey



I had the most delightful dialogue with the medical students of Penn State College of Medicine, Hershey’s American Medical Student Association campus chapter and Family Medicine Interest Group (@PSFMIG), on the topic of “Community Medicine.”

Ilene Tsui (@iktsui) and Carina Brown, first and second year medical students were my hosts. I had hoped to come to the famed city in person, then I realized it would have to be by video from Washington, DC, then I realized it would have to be by video from Denver, Colorado, but we did it.  It is very poor form to stand up medical students, so thanks to my executive-level colleagues for agreeing to catch up on some work in the lobby while we chatted. The commitment to the future is strong here.

Slides are below in two formats (slideshare and “easy access”). Ilene also sent me some questions before hand which I’d like to answer here. If anyone out there wants to answer them also, be our guest, more experience is better. Just post in the comments. Here goes.

1. How will medical education be changing over the next few years? Do you see residencies becoming more streamlined for those interested in specialties?

I’ll just insert my hope in here, which is that medical education will not prepare people to be excellent doctors, it will prepare people to be excellent leaders and citizens with the knowledge, skill, and behaviors of physicians to support individuals, families, communities, society, to achieve its/their goals through optimal health.

If we look at what the public expects from doctors now and in the future, it’s to be stewards of more than hospitals and medical offices. This is really good news, medicine is an incredibly versatile profession, there are many places and situations where we can heal.

I’m not sure what to say about the streamlined question. Might need more background on that one :).

2. Where do you see primary care practices in ten years? Do you think the concept of private practices will exist in ten years?

I think they will. The question is what will they be like. I had to go look up the data myself, because I’ve been in a group practice my entire career (and I’ve not looked back). According to this report, we’re set to be at 36 % independent physician practices by 2013, down from 57 % in 2000.

I’m clearly biased. I trained in a multispecialty group practice that supports collaboration for the health of everyone, saturated with technology, systems, and leadership training to make it all work.

Kaiser Permanente Rock Creek, Lafayette Colorado 19647

Kaiser Permanente Rock Creek Medical Offices. The future is here.

I think this is a good time for me to say, even though I wasn’t at the Center for Total Health in Washington, DC, when I was talking with you, my Penn State friends, I was still coming to you from the future. I was at Rock Creek Medical Offices, part of Kaiser Permanente Colorado (@KPColorado), and the day before at Skyline Medical Offices in Denver, where I was spending time with:

  • Dermatologists, who are using video technology to connect to their primary care peers (and their patients) to make sure they are excellent clinicians in their own practices, and make themselves available as clinicians as well. We were told the average time to see a dermatologist at Kaiser Permanente Colorado is now 3 days. Let’s repeat that: 3 days.
  • Neurologists, who are doing the same, using video technology also to connect, and in the foreground, synthesizing for every patient a substantial amount of thinking and knowledge across all their specialty colleagues for every single patient. A complicated neurology case can have 2, 3, 4 specialties consulting, and to have their work bundled together in one comprehensive electronic medical record is beyond priceless. And, it’s not just the bundling of their knowledge, it’s the bundling of their collegiality. To be part of the same medical group delivering the care brings a level of respect and commitment to that person and their family in the exam room that’s hard to replicate.

3. What are physician’s roles/responsibilities in social media? Should physicians have an online presence? How has this revolutionized the delivery of healthcare and of primary care, especially?

Yes.

I don’t know if any revolutioneering has happened yet. As I posted previously about what family medicine is, a specialty of depth about a person, a family, a community, this is a specialty whose outlook is tailor made for social media. We have unlimited curiosity about the world around us, we don’t want to talk as much as we want to listen. I might go as far to say that all physicians using social media effectively, regardless of specialty, have some of these traits; I invite people to compare and contrast though. It’s the beauty of the medium, you can compare and contrast – it’s their feed.

4. What are some innovative programs and organizations that are working towards improving community health? In what ways is this being accomplished? What are remaining barriers?

Too many to list. I’m going to use this bit of digital space to dialogue about organizations like Capital Bikeshare (@bikeshare), Washington Area Bicyclist Association (@wabadc), Black Women Bike DC (@BWBDC), AmericaWalks (@AmericaWalks), CommunityCommons (@CommunityCommon), GirlTrek (@GirlTrek), your local Department of Transportation.

These are just some that I’ve interacted with in the last few weeks – they are all working towards improving community health. They want to work with doctors. And we want to work with them. Pick your passion in health, there’s someone in your community that has it too and will love to see you there with them.

Possibilities are limitless. What barriers? All that’s needed is some imagination. Let’s just say that “MD” stands for “Maximum Diversity” in working to improve people’s lives.

5. For a student interested in primary care, what would you suggest one do with elective rotations? Are there some areas of medicine that will be more useful than others down the road?

HAVE FUN. The Dean of my medical school said to us, “when I get reincarnated, I’d like to be a 4th year medical student.”

By HAVE FUN, I don’t mean, don’t work hard. I also don’t mean “this is the last time you’ll enjoy your life” – believe me there are non-stop fun times ahead.

I mean, find those experiences that you can access as a medical student because you may be mobile, physically, emotionally, you dream about checking something out. I did a rotation at CDC, at National Library of Medicine (where I fell in love with Washington, DC, and couldn’t shake it even 13 years later…). Tweet people, send them e-mails, many of them will write back and say, “yeah, come on down.” Go.

6. Is there anyway to counteract the ever-shortening periods of time we spend with an individual patient or is that just a necessary byproduct in the mission to improve health on a population level?

YES. Never tolerate anything you think of as a “necessary byproduct.”

Who decided that fulfilling your mission to improve health means that you have to sacrifice your own? There are emerging models – check out Group Health Cooperative’s medical home: The Group Health Medical Home At Year Two: Cost Savings, Higher Patient Satisfaction, And Less Burnout For Providers

Don’t let the future be handed to you. Own it. I am counting on you to imagine the medical practice of your dreams and turn it into reality. You’re not actors in a play, you’re the screenwriters. I alluded to this in my presentation at the ONC 2011 annual meeting. Check it out.

7. Could you talk about the KP HealthConnect system; how it works, why it’s successful, room for improvement?

I could, but I fear this post would be even ridiculously longer than it is already.

Why don’t I just sum it up in 4 words:

4.1 million members online.

8. Best practices for engaging patients in their own health? How do you motivate patients to get active? What is the doctor’s role in promoting engagement versus the community’s role?

I want to clarify what “engagement” means. If it means “the patient is listening when the doctor talks,” that’s not a role that interests me.

If it means, “we listen to the patient, their family, their community, society” that’s the role. As my mentor David Sobel, MD (@KPHealthyFun) says to me, “everyone is motivated, Ted.” They are. I bet you won’t meet a person in your life who hopes to be sick, in pain, unable to be a person, citizen, brother, sister, mother, father, daughter, son.

It’s going to be hard sometimes, because you’re going to be tired, stressed, depressed, happy, sad, but just try it. Sit on your hands and listen 10 seconds longer than you think you should. With your ears AND your eyes.

9. For med students interested in community health, preventative care, family medicine, and public health, what are organizations or activities that you recommend we get involved with to continue exploring? Looking back, what were key experiences you had during your training?

That’s as varied a list as there are people. I did something wierd in retrospect, I interrupted medical school for a year and got a public health degree. It was life changing in a way. In another way it threw me off because I hopped of “the track” of medical education, and after that it always felt like a game of catch up. Then again, I was never going to be on the track, talk to Regina Holliday (@ReginaHolliday) about that.

10. In your opinion, what has been the greatest innovation in medicine over the last 5 years and looking forward, what area has the most opportunity for improvement (communication, technology, education, information tech, social media, etc)?

Phew, easy answer time!

Listening.


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