Anne L. Finger

We are moving up Moore’s outcomes scale to reach Level 6—improvements in patient health. We can visit YouTube and see longtime CME guru Lawrence Sherman telling a Dutch medical audience at the 2011 TEDxMaastricht Conference that it’s time to turn medical education “inside out and upside down,” so that doctors deal with patients from Day 1 in medical school and throughout their careers. At the same conference, a man who calls himself “e-patient Dave” receives a standing ovation when he describes his journey from stage 4 kidney cancer to remission and urges attendees to involve the patient, ”the most underused resource in healthcare.”

Clearly, CME has discovered the patient. The wonder is why it’s taken us so long—though not everyone in CME is a clinician, we all are/were/will be patients.

The question, then, is how do we put this underused resource to work?

Use Patients’ Voices
Patients who understand their treatments can be powerful advocates for good care—for their peers as well as themselves. The Internet has an abundance of patient bloggers who report the findings of scientific meetings. Timely translations of new data with immediate clinical applications from such a source may reach patients in a way that the physician cannot—thereby encouraging adherence, that major treatment issue. Perhaps the “blogging patient” can be incorporated into some yearlong online activities, providing valuable commentary on the real-world implications of the treatments under discussion.

Many of us have used videotapes of simulated patients in our activities. In a series on schizophrenia a few years ago, we featured a psychiatrist who not only treats affected individuals, but also trains police officers to recognize and manage people with schizophrenia. Her nuanced, multifaceted portrayal of a woman with schizophrenia made for both compelling and instructive education.

Similarly, videos of real patients can be eye-opening. A colleague reports that a highly scientific and rather dry symposium for hematologist/oncologists on the epigenetics of chronic myeloid leukemia and cutaneous T-cell lymphoma was enlivened by interspersed video snippets of patients. A woman suffering from the latter described her symptoms: “Picture this:  It’s 100 degrees outside, with 100 percent humidity, and you’re wearing a 100 percent wool sweater that’s three sizes too small. That’s how bad the itching is.”

Bringing Patients to Live CME
The incorporation of actual patients into a live meeting is a logical next step, though it is a bit more problematic. Controlled, edited interviews give way to more spontaneous exchanges. And unfortunately, it’s sometimes still true that, as an oncologist told me recently, “doctors don’t want to hear from patients.” We’re all aware of clinicians who can barely hide their exasperation when a patient offers Web-accrued knowledge to assist in the differential diagnosis. Some doctors feel that their high-level scientific meetings are not the place for reports from patients.

I now view that attitude as another barrier to optimal care that CME must overcome. Medicine serves us all best when both the patient and the doctor recognize the importance and value of their collaboration. As the tag line on the e-patients.net Web site reads: “Because health professionals can’t do it alone.”  

Anne L. Finger, MA, is the executive vice president of Veritas Institute for Medical Education, Inc. Reach her at anne.finger@veritasime.com. She thanks Betsy Dennison, MS, FNP, for her cooperation with this article.

The opinions expressed are those of the author and do not constitute the views of Veritas Institute for Medical Education, Inc.

More of Anne Finger’s columns:
CME Credits for Altruism?

CME Grants from Multiple Sources