Wednesday, June 24, 2015

Bring A Laptop To Your Next Doctor's Appointment

When I started teaching at Northwestern in 2005, it had been a quite a few years since I'd been in an academic setting for anything other than guest lectures. In the time that had expired towards 2005, the students all had laptops and the classrooms had WiFi. I thought the students were taking notes and reading email. They were not. They were double checking everything I said in class against Google search results.

It took me about 20 minutes into my first class to realize what was going on... it really caught me guard. I had a slight panic attack, paused, and mentally concluded, "There's no changing this situation, unless I ban laptops from the class.  That won't work. I better tighten up my game and make sure I make it very clear to the students what I definitely know and what I sort of think I know." I had to lay ego aside and turn this new access to real time knowledge on the part of the students into a group learning experience, so that my class lectures had better outcomes as a consequence. I had to let go of the ego that is associated with being the "professor" and admit to myself and the students that I didn't know everything-- collectively, we knew more. Better academic outcomes through student engagement in shared learning, boosted by technology and the plethora of knowledge that is now at our fingertips... radical idea.

When will that same sort of dynamic learning environment be commonplace in the physician's office and hospital room? It's way overdue. When we, as patients, are brave enough to enter a physician's office with a laptop and engage in this sort of co-learning, decision making, and patient engagement, the walls will come down.  Patients have to lead this-- I can't imagine very many physicians inviting you to bring your laptop and participate as an equal in the decision making and learning.  Like me, physicians will at first be caught off guard, but if a physician is unwilling to adjust and participate in this sort of patient engagement, we need to take our healthcare elsewhere and we need to be public about why we did so.

A few years ago, the BMJ published a study which revealed that physicians are 15 times more likely to change their clinical orders and protocols if presented with data, at the point of decision making, that substantiates the change. We have to start embedding better analytics and decision support in EHRs, but we also have to start embedding better analytic and decision support in patients themselves.

Below is a Facebook post from a dear friend, also in the healthcare analytics and decision support world, which prompted this blog. His story is a sad reflection of a common scene in healthcare.

"My dear friend, I thought I would share an experience of a relative with you, as you and I both work in the analytics research. Recently, Stanford University published a peer reviewed journal article on the correlation between Proton Pump Inhibitors (PPIs) and increased risk of heart attacks. A relative called me up and asked about it. I read further on their research which looks at the relationship between these two factors, even after accounting for and excluding known drugs that interact with PPIs. I called back my relative and suggested they ask their physician to change medicines. My relative met with their physician to request a change of their medicine to one for which there is no known relationship with heart attacks. Instead of looking at the recent research, the physician told many of his patients that the relationships with heart attacks are only for patients taking a particular medicine. The publication CLEARLY said that was not the case. In other words, the physician would rather risk having his patients die of heart attacks than take the time to read the summary of the paper and consider changing his patients' medications. This, in my mind, is a form of medical malpractice. In the analytics field, we can build the analytical approaches and software tools. However, if there is a certain culture and lack of accountability, egos may trump scientific evidence, ultimately leading to worse clinical and cost outcomes. I guess I will, G-d willing, mail a copy of that research paper summary to my relative and ask them to show it to their physician!"

Monday, June 1, 2015

Mountain Biking on the Colorado Trail: Personal and Professional Connection

This post is mostly intended for our little girl, Anna, as a record of her father's favorite hobbies, but there is a professional message behind it, too.

In 1959, I was born and raised in Durango, Colorado, now a mountain biking mecca. At the time of our childhood, it wasn't called mountain biking, but that's what we were doing with our bikes, mostly Stingrays. There weren't very many trails at that time-- literally only a handful of man-made trails, but mostly they were wild animal game trails or trails used by the local ranchers to move their cattle and sheep from pasture to pasture in the forest. We would ride our bikes as far as we could on these rough trails, then push them to the top of the next hill, and repeat the process until our little legs were exhausted. We'd pause at the top to admire our achievements, then plunge downhill, as fast as possible. Wrecks were the norm. Helmets were non-existent.  Shocks were non-existent. We routinely broke seat stems, handlebars, and front forks. A few of our friends, like Everett Berry, benefited from the welding skills of their fathers and older brothers, and would reinforce their Stingrays with various metals, Mad Max style. I weighed my Stingray one time, without any of these metal reinforcements-- it was 33 pounds. I weighed 75 lbs at the time.

Times are much different now. There are miles and miles of incredibly well-made, man-made trails all around Durango, thanks in large part to Trails 2000. If my math is accurate, I counted 19 trailheads in the city limits of Durango itself, not to mention the trailheads that are immediately outside the city limits.  The mountain bikes of today are from another planet in comparison to what we rode as kids.

I'm not entirely sure what impact this sort of upbringing and on-going hobby have had on my professional life, but one would think the impact has been significant. Camaraderie, balancing risk and reward, an inner life that is firmly anchored to the permanence of Mother Nature not the fleeting impermanence of Mother Business; and nurturing a sense of fun... all of these things come to play.

I'm incredibly, endlessly grateful for the health-- and friendships, like Steve Harmon shown in this video, and David Waller and Dan White not shown-- that still allow me to enjoy mountain biking, now into the 55th year of life.


Nuclear and Healthcare Decision Making

Nuclear warfare operations was my data-driven decision making environment before the healthcare phase of my career. It was all about recogni...