Saturday, May 12, 2012

Convocation messages

I attended a medical school convocation ceremony this weekend with a about 300 young people transitioning from being medical students to medical graduates.  A lot of positive vibe going on with satisfied students and appropriately proud families and friends.  It was a re-enactment of a tradition that goes back for hundreds of years.  It reminded me of my own convocation ceremony and gave me opportunity to reflect upon how much I had learned in medical school and how little I knew and understood.

It is perhaps a reflection of my last 30 years, but as I heard the occasional presentation by the Associate Dean of the school, I actually listened to what he had to say.  I know that his goal was to be aspirational, but I wanted to give a commentary response.  Fortunately I had enough foresight to keep quiet.  Convocation presentations are not intended for discussion and debate. 
First, I could not agree more with his advisement to the class that society gives physicians the awesome authority by which with their signature on a piece of paper they can provide people with medications, can allow people to either remain off or return to work, and most importantly can spend very large sums of other people’s money (OPM). 

I have always been aware of the close connections between OPM and OPIUM.  Consuming both can provide a certain amount of pleasure and sense of power, but can become dangerously addictive and can lead to ruin.  Extensive over-ordering of tests can become a problematic habit and a danger to Quality. 

Somewhere along the way medical students should learn very early in their careers that ordering every test is a good defensive strategy to prevent being sued.  A better message is that inappropriately excessive tests costs the system a fortune, but does not provide more information; it indeed provides less.  Over-ordering tests leads to diagnostic confusion, false positives, and leads to more repeat tests and more supplemental testing.

Here’s a thought; if docs want to order tests for their own purpose, there should be an insurance code where the charge for the test is billed against the physician, not against the patient.  If you want it just because the information would be “nice to know”, then you should pay for it yourself.   

When students learn that over-ordering is both bad medical practice and poor patient care, and a tragic waste of other people’s money (OPM) they have learned a valuable lesson. 

Unfortunately in the same presentation, the Associate Dean commented that when students came to medical school they were both unknowledgeable (true) and ignorant (maybe a little strong!), but over their 4 years of education they learned not only how to perform medicine, but also how to speak medicine.  They learn the language of medicine that allows them to speak to other colleagues.  They had learned the “special words”.  I agree with him that that is what medical students learn, but I have to disagree with his intent because I understand the term “special words” to mean the same as “jargon”.  

As I have mentioned here before, I do not consider speaking and writing in jargon a good thing, I consider it a potentially dangerous crutch that needs selective use and containment.  We don’t go to school so that we can talk with other doctors.  We go to school that we can communicate and assist patients.  Patients need to understand what we are trying to say and saying it with “special words” does not help.  As pointed out before, today and even more tomorrow, our laboratory test reports and surgical reports, and medical notes are viewed as the proper property of our patients.  It is not the obligation of patients to learn how to understand our “special words”, it is our obligation to create information in a manner and text that people can understand without being trivial. 

Inevitably there will always be some words that need to be part of common dialectic; words like Calcium, and Haemoglobin, Thyroid hormone, and Staphylococcus.  But at the same time when we use these words we need to supplement them with text that allows people to understand our interpretation of results.  This will not be easy.  We have become very comfortable within our own jargon. 

We do spend some time learning how to speak to patients but is not a priority for students in the same way as jargon is.  But is something that our future students will have to learn.  It is a matter of communication and a matter of Quality care.

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