A few weeks ago, I contacted several PCCM fellowship directors to ask that they encourage fellows to share teaching conferences and points-of-view on the ATS blog. I received no response from two directors but a third was eager to engage.
For the record, this PD is a great talent. He is a nation-leading educator, scientist and – by all accounts -an excellent clinician. I’ll distill and paraphrase his response: fellows only have 3 years to get a huge amount accomplished. It would be a disservice to encourage them to produce content for the blog, deflecting their limited time/attention away from their once-in-a-lifetime opportunity to build the foundation of an academic career. Incisive on first glance.
Three years ago, I left formal academia – and it has been an epiphany. In a country where everything is being blown up with the assumption that the system needs real change, I offer the following (in that spirit): American academic medicine might benefit from trying new approaches. Why would the current model, espoused by the PCCM PD, require revision?
I propose that the current model – of training young minds to produce in the ivory tower of academia and its journals – is, by itself, a failed system. There is no argument that the current system produces excellent science and an abundance of advances to improve medical care. However, it takes decades for major scientific advances that save lives to be applied in the trenches of community medicine.
In my (albeit jaded) experience, money – not an abiding professional ethic – seems to be the primary driver of therapeutic change. Whether it’s PHARMA pushing a new medication, application of expensive devices/technologies or simply spending enough time with a patient to hear their story sufficiently to provide a thorough analysis, money drives the system. If you disagree, then answer the following; why did it take more than a decade AND public reporting/non-payment to get >90% of patients with MI an aspirin and beta-blocker?
We can squawk about the intrusion of government in medical care, of the inappropriateness of protocolized care to the individual patient at hand, of the erosion of clinicians’ autonomy. But the old system doesn’t get the great science to the bedside nearly fast enough. The idea that academic medicine’s social responsibility ends with publishing good scientific research disserves public health. If we’re to lead healthcare we need to fix this second missing “translational” piece. (And if we can’t “own” this part, we just need to produce the science, shut up and let bureaucrats tell us what MUST be done at the bedside).
So how could new media platforms – blogs, Facebook, Twitter – be harnessed to “translate” best science to the bedside? Imagine if Facebook offered a modified and souped-up version of Choosing Wisely to its millions of users. How many (million) fewer patients would insist on azithromycin for their viral URI? The ATS has started a pilot project in which critical care experts briefly explain, in layperson’s words, a complex illness/problem and provides them with questions to ask politely of their caregivers . . . to encourage application of best practices. While many patients will be too intimidated to engage physicians this way, at least half of my patients/families would probably run with it. They’re not a childlike/demure as some suggest. Or imagine if ATS offered twitter feeds (perhaps some intended for patients and some intended for physicians) to broadcast when major studies or consensus statements are published.
The ATS blog is an experiment of sorts. We don’t know how best to harness its potential. Medical journals, however, are hesitant to dedicate space to even the best-informed “opinions” or “how I do things.” Beyond a few formal letters, there is very little opportunity for readers/clinicians to engage the experts who produce the science. And for the experts to share (and argue for why) their approach to an illness they know most about. The ATS blog could become a place for clinicians to share ideas in a more casual milieu; a vehicle for translation.
So back to my discussion with my program-director-friend. Even the most prestigious fellowships have a few trainees who haven’t caught fire with research. Maybe they never will. Maybe they simply haven’t found a topic or platform to catch fire. Participation in peri-academic media might be another way in, for them to ignite and either find a topic that turns them on, or to become innovators in translational science. When John Hansen-Flaschen asked me to help launch this effort, I was dubious about its potential impact (and my handicap really needs work). It may never catch-on for the ATS. But it takes only a little imagination to envision how it could do a whole lot of good. And for me, even the potential of such juice is worth the squeeze.
Postscript: As I completed this essay, I learned that our blog may wind down in April. John Hansen-Flaschen, an old-school legend who you might not expect to see the potential benefit of new media, launched this effort. And while its exact fit with a journal is still vague, even to me, I suspect a time will come when we harness new-age technologies to empower clinicians and patients, and translate science more quickly to the bedside.
Constantine Manthous – For over 20 years, Constantine Manthous, MD, has taught, researched, and practiced in the intensive care unit. His research has addressed a panoply of practical problems with a focus on weaning from mechanical ventilation and end-of-life ethics.