The emphasis on evidence-based medicine, technology, and guidelines brings much good. But we may be losing something along the way
There has been a groundswell of support for CME that focuses on performance improvement. However, is there a danger that the emphasis on so fully evaluating clinicians' management of their patients against evidence-based medicine and treatment guidelines — which the CME community has quickly embraced — will move us further away from the practice of the art of medicine?
Many physicians devote a minimum of 12 years to learning their craft. One of the most important lessons they learn: There is no such thing as a “typical” patient. Yet they are being asked to follow a one-size-fits-all approach that may not, in fact, fit the patient at hand.
Diagnosing the Problem
Before MRIs, CT, PET scans, and a host of other state-of-the-art diagnostic equipment, physicians relied on their own knowledge and training to diagnose their patients. I recall a conversation with my uncle, a retired trauma surgeon, about his early years in a busy emergency department. I asked, “How were you able to figure out what was wrong with people — you didn't even have MRIs?” After an uncomfortable silence, he said, “Annie, my dear, we used ‘these’ (holding up his hands) and something called ‘medical school training.’” The other question that begs to be asked: Is traditional medicine becoming a lost art?
True, we have more advanced technology to validate a physician's diagnosis, but did patients receive a higher quality of care when doctors made house calls and spent more than 10 or 15 minutes with their patients in the exam room?
With increased emphasis on PI, now more than ever we need the input from the physicians our CME activities serve. What clinical challenges do they face? What are their patients' true needs, both clinical and otherwise? Maybe what patients really need is a healthy, unhurried dialogue with their doctors — one of those old-fashioned discussions where the doctor says, “That toe is probably broken, Mrs. Jones. We can send you to X-ray, where they will confirm it in about three hours, or I can tape it up right now and send you home with some aspirin — and you'll save three hours and several hundred dollars.”
Maybe what's best for patients is a scenario in which doctors are encouraged to provide their clinical opinion and use their years of medical school training, combined with CME, to make a treatment decision based on what is best for the patient.
Traditional CME that educates clinicians about how to manage diseases (including evaluating pharmacologic therapies and conducting safe and effective medication dosing, side-effect management, and treatment compliance) remains the cornerstone of postgraduate medical education. PI is an important component of CME, but it is up to us providers to help physicians get to a “gold standard” of clinical care. So let's continue to examine multiple approaches for accomplishing this task. Most important, let's listen to the doctors themselves.
Ann C. Lichti, CCMEP, is the vice president of health care education strategy for Veritas Institute for Medical Education Inc. Reach her at firstname.lastname@example.org.
The opinions expressed are those of the author and do not constitute the views of Veritas Institute for Medical Education Inc.