My Medical Interests
As some of you may know, I was once a resident in an Emergency Medicine residency, and after a rather wandering road, am now back in residency - this time in Internal Medicine.
When you enter an EM residency, your life after that is pretty straightforward. There are a few fellowships (Pediatric EM for example), but most people graduate in 3 years and start practicing. IM is a bit different - there are an enormous number of fellowships, and even if you don’t do one, you still have choices. Private vs Academic, primary care vs hospitalist. Group vs solo. Etc.
I still have some time before I finish my residency (Jan to Jun of 2007), but need to start figuring out whether I want to pursue a fellowship. Consequently, I need to decide what I want to be doing in 5, 10, 30 yrs…
First, I am glad to be back in medicine. It was the right decision to leave, and more importantly, it was the right decision to come back. I enjoy patient care. I enjoy teaching. I enjoy learning.
But I still don’t know exactly (who does?) what I want to do with it, though. I want to continue to see patients, but I also am developing interests in medical informatics, and in finding ways to “improve the healthcare system.” That’s a rather big pie, and I am still trying to figure out the pieces I wish to pursue.
So this page will serve as a running list of various snippets of things that interest me. I welcome feedback, suggestions, people with similar interests who want to discuss them, etc.
In no certain order:
Evidence-Based Medicine - you would think this would not be as “controversial” as it sometimes is. I am always surprised to hear someone who disagrees with EBM - is there any other way to figure out what works?
Medical Informatics - I truly believe that information technology can really be used to transform healthcare for the better in huge, as yet unimagined ways.
Medical Decision Making - as our knowledge base grows, and the number of diagnostic tests skyrockets, it will become increasingly important to have assistance with incorporating this information into our patient encounters. It’s not a stretch to see various tools that attempt to provide assistance with making diagnoses, determing best courses of therapy, etc. These tools won’t replace physicians, but rather will allow physicians to do what humans do best - discuss the information with the patient and apply it to their individual situation to do the “right thing.”
Healthcare Reform - I hate politics. Perhaps that’s why I should get involved somehow. Things are going to get worse before they get better. I would like to help them get better.
Death and Dying/ Palliative Care/ End-of-Life Issues - it’s a cliche, but death really is a part of life. It’s easy for doctors to ignore the dying process, or treat it as a failure. I think it’s really helpful to a patient and their family when their physician helps them die well. (And, trust me, there are lots of ways to not die well….)
Personal responsibility - I see a lot of shirking of personal responsibility in health care (and in other areas of life…) Whether it’s surprise at the health consequences of behavioral choices, or expecting society to pay ridiculous amounts of money for medical interventions with little benefit, frivolous law suits, etc. This might be a problem with America as a whole, however…
Medical education - we are way behind when it comes to how we education students, residents, and practicing physicians. We know that lectures don’t work, so why do we still require them for ongoing certification? There is a lot of room for improvement here.
Medical Errors - I am interested in how we can use technology to help catch and prevent medical errors. I believe they are increasingly likely to occur with the growing division of healthcare (nobody has just one doctor anymore…) and with the ever-expanding body of medical knowledge (no one can keep it all in their head.)
Electronic Medical Records - I was FLOORED when I saw some articles suggesting that the Bush administration was looking into open standard solutions for EMR. Finally, someone might possibly be thinking about the problem rather than buying into the usual proposals by monolithic software companies suggesting closed, proprietary standards. There’s hope yet.
Fixing the damn system
I also want to start to develop some research questions that I would be interested in learning more about. I will try to add those here as well.
Again, I welcome comments…