- KevinMD and now the usually sensible Shadowfax continue to be wrong on teaching the business of medicine. (Don’t get my wrong, I completely agree these things should be taught, but it makes absolutely no sense to have the primary teaching be in med school.) Teaching it to pre-clinical students certainly makes no sense, they’re busy learning everything for Step 1. Teaching it to clinical students isn’t all that practical, as most are preparing for residency applications and wrapping up med school. (And my main point here: if you don’t use knowledge, you lose it. When will anyone but a senior resident be doing any sort of billing or admin stuff? You think an intern is going to retain knowledge of CPT codes? Perhaps if they’re in a continuity clinic or something–but then that’s something they should be learning on the job, in the clinic. Again, every single EM residency program I’ve seen so far has 2 weeks set aside for “Administration” in the final year, but honestly, if you all think it’s so important, residency programs could certainly find time for it. You could have it coupled with two weeks of X to make a 4 week block; you could have a morning lecture series for all the residents, or dedicate one noon conference every month or something to the topic. Med students are so far removed (remember, we’re not even DOCTORS yet)–what’s the point of filling our head with information that will just be quickly forgotten when it’s much more important for us to remember the possible side effects of ACE inhibitors we’re about to be pimped on?
Beautiful irises (irides?) from this artist. Of note, no Kayser-Fleischer rings appreciated (see photo).
- Insurance does matter for cancer prevention, as Matthew runs through a recent study: “For all cancer sites combined, patients who were uninsured were 1.6 times as likely to die in five years as those with private insurance.” This is sadly one of those “duh” studies that has to be done anyway, because of well-insured, financially-secure naysayers who somehow believe their situations are no different from people without insurance.
- Ignore those calorie burning meters at the gym. There’s almost nothing more inaccurate in the fitness/weight-loss/exercise world. I’d previously heard the eliptical machines overestimate by 20%, but this article claims they’re just plain wrong. Break a sweat (after approval from your doctor, Mr. Quintuple Bypass with Chest Pain at Rest), and exert more than you take in. 1 pound = 3500 Calories. 500 less Calories a day = 1 pound of weight loss a week. Slow and steady wins the race.
- And finally…Google Talk introduces instant translation in IM conversations. This would be pretty awesome in medicine, if we ever chatted with patients. (Damn you, HIPAA!) The translation is actually pretty good, at least for Spanish. Your pretty typical conversation in the Emergency Department:
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hi g,
congrats on FINISHING. huzzah for you!
you probably know this, but the Spanish google translation gets words right but number, tense, and sense wrong at times. it’s not bad – -it’s one of the best i’ve seen, but i’m just sayin’, being a Virgo and all.
kcd
[...] has been keeping up with recent rants in the medical blogosphere regarding the apparent unpreparedness of medical [...]
As a medical student, you don’t need to know the difference between a 99284 and 99285; however, knowing that the two systems of codes (and the RVRBS) exist and why lays a critical foundation for understanding the rest of the medical economic landscape. It’s as important and more relevant than the Krebs cycle ever will be. (why they persist in teaching that abomination…)
The reason to teach this in med school is because during the first two years you are in lecture anywhere from 10 to 30 hours a week, depending on the school, and all students attend (in theory). It would be relatively easy to carve a small space carved from that time. In residency, you get maybe 2-3 hours of lecture a week, at best, and maybe half the residents can attend, the other half being on off-service rotations or post-call or what-not. And the admin rotations are a joke. Obviously it varies, but there’s no standardized curriculum, and each director’s idea of what is important in administration varies (in academic programs it tends to revolve around inter-department turf battles).
Both Med school and residency have test-driven priorities. Med schools focus on getting you ready for the USMLE; residency focuses on the in-service exams and the boards. When you only teach to the test, *real* mission-critical educational items get lost.
Look at the landscape of emergency medicine: about half of the national contracts are controlled by national contract management groups; new docs get exploited financially and forced to work all nights; docs get raped by insurance companies. If docs had been getting some minimal exposure to business education before being let loose into the world, things might be different.
A patient walks into a hospital and says:
“Doctor, me duele el alma.”
Doctor says, “sorry we don’t do alms.”
i’ll just comment emergency medicine probably has the hardest time coordinating meetings due to schedules, residents on loan, and multiple hospitals being covered.
in my residency and 3 fellowships, i had no less than 10 hours of mandatory educational meetings a week at all 4 stops. frequently more. i don’t know how long ago shadowfax was in training, but now it is death by conference. they used to teach you during conferences but now they force the trainees to try and teach each other. of course they don’t give them time to learn the material before trying to teach it.
even if programs wanted to spend the time, which in retrospect we did have a big huge 2 hour conference on billing the first day at my last fellowship, they send in the billing people to teach it. you get a list of things you have to say before you even know what the things on the list mean. didn’t help a whole lot to the naive. in training, you have no idea what level the attending is going to bill, for example. so how are you going to dictate to support that level? idiots. anyhow, they didn’t teach you the landscape, they taught details of billing meant to protect the program from fraud and/or to make the lives of the billing people easier.
ymmv
Good find on the Google Talk! Google translate requires a lot of caution, though–I once saw a resident get burned by a bad Google translation of a seemingly simple phrase. Definitely requires a check-over with a good dose of common sense, Hamel’s Dictionary of Spanish False Cognates, and ideally a human translator before going on the discharge instructions.
“Doctor, me duele el alma”…
he don’t need a doctor, he needs a drink.