Jobs for the 21st Century Hospital & Healthcare Systems: Introduction

In Australia in 2010-11 Healthcare and Social Assistance accounted for 11.4% of employment, bypassing the retail, construction and manufacturing sectors. Around the world healthcare is a growth area for employment and it consumes progressively larger portions of GDP. The traditional hospital consisted of two types of staff – clinical staff or doctors and nurses, and support staff or administrators and cleaners, etc, etc. But staffing needs change over time. For example 30 years ago who would have said hospitals and healthcare systems would need departments of information technology and Chief Information Officers?

This post flags the start of a new series of blogs on new job (descriptions) for the hospitals and healthcare systems of the 21st century. Some of the jobs I’ll post about will include implementation scientists, behavioural economists, social media managers, big & small data analysts, molecular pathologists and diagnosticians, medical history curators, dignity therapists, disease forecasters, system navigators, and prevention strategists, to name a few.

If you think there is a new job that hospitals need then let me know through twitter @wsliauw

Things they didn’t teach in medical school: Part 26 – Giving fitness advice

Yesterday I wrote how medical school doesn’t teach much about giving dietary advice. Well the yin to diet’s yang is fitness and exercise. This is also a commonly asked question – what exercise can I do? Is it OK to exercise? Well this is important for both the sick and the well….and I’ll make a confession – I’m not one for formally exercising although my fitbit tells me that generally I do more than 10,000 steps a day.

In some cases it isn’t good to be physically active or to undertake certain exercises like heavy lifting – for example, if you’ve just had abdominal surgery you might increase your risk of hernia. Certain types of exercise – like heavy impact contact sports might be dangerous for a person with bone metastases. But in general keeping active, if not actually exercising is important.

After a stay in hospital many individuals are deconditioned. This happens very quickly with any bed rest – just like an athlete in the off-season. In this case getting back to exercise is very important for return to normal quality of life. There are simple things to do: use a chair for support to stand up between commercial breaks on television, climb back and forth along a small flight of stairs (with a railing) and take progressively longer walks around the neighbourhood (checking out their mail boxes).

Increasing exercise and fitness levels may be important in very specific conditions such as rehabilitation after heart attack or heart surgery, patients with chronic airways disease or after cancer. Increased activity after cancer may actually reduce risk of relapse and prolong life expectancy – the trials are ongoing. Frail and elderly patients may benefit from exercise to reduce falls.

The other aspect of exercise is how to do it. Recent evidence suggests that prolonged periods of exercise are not necessarily the best way of achieving fitness (and weight loss). Interval training with short bursts of intense activity may be more effective. Mixing up different types of exercise might be important for achieving different aims.

Doctors and future doctors need training in giving advice on fitness and exercise.

Things they didn’t teach in medical school: Part 25 Giving dietary advice

One of the commonest questions my patients have is “What should I be eating?”

Interestingly, I don’t think I was taught very much about basic nutrition at medical school. We did learn about the deficiencies such as scurvy (vitamin C) and beri beri (thiamine) but I don’t think we were taught much about normal nutrition. We definitely weren’t taught anything about nutrition in sickness or aberrant nutritional status. This is somewhat unfortunate as most of my patients are either malnourished as a consequence of their cancer or the treatments for their cancer. Living in modern society, most of the remaining people I see are overweight.

Now, you could argue, as the Nutrition Science Initiative does, that we don’t actually know what the ‘correct’ diet is and that most of what has been taught or is understood is wrong, or flawed, but I guess you have to start somewhere. Currently the debate is raging around whether the culprit for obesity is fat, carbohydrates or sugars, or lack of exercise. Various diets – vegan, paleo, Atkins, Mediterranean, etc – argue over the proportions of fat, sugar, carbohydrates, sugars and proteins allowed in the diet. Regardless of the best proportions the fact is that if doctors asked their patients they would soon discover that many wouldn’t know which foods contained what.

Future (and current) doctors need to be taught the best available information about dietary composition and also the behavioural techniques that have been demonstrated to assist in weight loss (or gain). Doctors also need to know how to manage the malnourished patient. Now we can turn to dietitians and nutritionists for advice this is knowledge is so intrinsic to healthcare that it should be considered essential learning. And besides….we might improve the hospital food.

Nutrition Science Initiative NuSI

Prescribing a diet