Fist Bump against Flu

Last year a simple fist bump by President Obama got politicized.  But this year it has come back with a new purpose.  With the swine flu pandemic threatening to get worse with students returning to school and college and the seasonal influenza season just a few weeks away, hand washing has become the mantra for flu prevention.  

But what if you don't have your hand sanitizer ready.  Every time you shake hands you worry about contributing to the spread of the virus.  For physicians it is a specially relevant issue.  You walk into an exam room and shake hands with your patient.  Everything you touch thereafter has a chance to get contaminated - the keyboard, the mouse, the table surface, the stethoscope etc.  Even though you sanitize your hands religiously between patients, you probably don't sanitize them right after each handshake.

Enter the fist bump.  Walk into the exam room and do a fist bump with the patient.  Not only does it prevent your palms from getting contaminated but it gives you a great opportunity to start talking about the flu.  We know that patients put a high value on their physician's opinion.  A fist bump to start the office visit will give you a great chance to mention the importance of hand washing and educate the patients about how to prevent the spread of the virus.

I tried this today with all my patients and it worked!

What do we need in Health reform?

Just read this article in the NY times by Pauline Chen M.D. Also I just recently completed my in-patient rotation in the hospital where I was very disheartened by the fact that almost every patient I saw had been in the hospital recently and was very likely to get readmitted in the next 6 months.

Our burden of chronic disease is huge and growing. In a lot of cases the patients' lifestyles contributed to the chronic disease. We are spending huge chunks of health care dollars to treat these patients and keep looking at ways to cut this spending to decrease health care costs - the totally useless "length of stay" parameter comes to mind.

What we need to do is invest in the future so we can change lifestyles before they lead to chronic diseases. Also, we need to provide early treatments of chronic conditions like hypertension before we get into renal failure, heart failure and strokes. This will let us have a healthier productive tax-paying population that will help balance the budget.

The article points out how frequent contact between physician and patients may help in changing lifestyles and improve compliance with medications. With the advent of social networking tools we don't need to physically bring the patient into the office for this purpose. We can repurpose/create secure social networking tools for this.

The barriers:

1. Physicians are inundated with work... a lot of it due to bureaucracy - filling out forms, documenting for purpose of billing, multiple pharmacy call backs due to multiple/illogical formularies
2. There is no model for reimbursement for physician-patient contact outside of the office. And the payment is for the complexity of the office visit. Thus if you call and talk to the patient 15 times in a year and get him to take his meds, exercise and lose weight, you would be paid zilch! But if you see him twice a year, give him more medications as his diabetes and blood pressure go up and he gains weight, and then see him in the hospital when he get a heart attack you gets tons of money.
3. Due to point # 2 the health care system is too top heavy with more specialists than generalists. Hospitals have invested huge amounts of money into high tech and not much into prevention.
   

If we want physicians to work with patients to prevent onset of chronic disease or complications of chronic disease, we need to change our financial model for reimbursement. We need to pay health center to prevent outcomes. We need a secure networking tool that can allow patient - physician communication, motivational "interviewing", and a way to pay for this.

Do our medical schools need to adopt new education technology?

A recent article in Campus Technology by Trent Batson "Horns of the Dilemma for Faculty: Legacy Demands and Technology Expectations" discusses how universities have failed to change while educators have adopted all the web 2.0 technologies at home. Also there is this terrific presentation.

Purdue Tlt 09 Robbins

View more presentations from Sarah Robbins.

How does this apply to medical education? Is it important to adopt new technology for teaching our medical students? I love technology but I find myself thinking that the battle we need to fight is to make medical school education more student centered and not necessarily the immediate adoption of new technology.

Going from lectures to problem based learning is more important than changing the old chalkboards to electronic whiteboards! Getting our medical schools to move from grades to portfolios would be worthwhile cause to fight for but Portfolios can be done on paper. Students can use a paper textbook, they don't have to start medical school with a Kindle DX loaded with all their textbooks. Students can go to a "real" classroom as long as the "teacher" promotes active collaorative learning, they don't need the presentations loaded on their iPod or a virtual classroom.

Once we get our faculty to adopt a more collaborative and active learning approach, the adoption of the appropriate technology will follow. Technologies will be superseeded by newer ones, but the key principles of education should be more enduring. The current web 2.0 applications seem to be designed perfectly for collaborative learning and it would be great to integrate these into our curriculum delivery and assessments as we make adopt a more constructivist approach to medical education. But if I were to have one or the other, it would have to be the collaborative learning approach and not the technology! It does not have to be a dilema.