Things they didn’t teach in medical school: Part 21 – you can do more than look after patients

So I don’t really like the title I came up with, after all, looking after patients is pretty important. What the title refers to is the observation that medical training equips you for more than medical practice – although nobody teaches you that.

I haven’t quite reached the point of abandoning face-to-face patient care but increasingly I spend my time undertaking activities that might be considered influencing care rather than undertaking care.

It is often observed that many people with law degrees don’t end up being day-to-day lawyers. Well this probably applies to a lot of the core professions. Last week I ran into a basic scientist who now has a job as a research strategist and commercialisation advisor.

So what is the common theme?

Professional training really consists of two themes. One is largely around the technical knowledge relevant to the discipline – i.e. the law for lawyers, economics for economists, anatomy/physiology/pharmacology for doctors, etc, etc. The second is around problem solving. Professionals/experts fundamentally have the job of correctly identifying problems and questions and then trying to solve them. In medicine my job is to ‘diagnose’ the patient’s illness, prioritise the management problems and solve them.

Now, as I sit on hospital administrative committees and company boards, my job is the same. Identify the problem and find the solution.

This week an end came to an advisory committee that I have sat on for the last 6-7 years. The advice was around eHealth and electronic decision support. Whilst I do have some understanding and technical knowledge of these areas my real contribution to the group was to look at problems from a different perspective, to re-define the problems, to re-calibrate the discussions. This was also the role of my fellow committee members who were often drawn from different professions or different versions of my profession.

Some of my colleagues and peers make a complete jump and leave day-to-day medicine altogether to pursue apparently different careers. I’m pretty sure they are out there diagnosing problems and finding solutions.

Not a good week for the Therapeutic Goods Administration and QUM

The Therapeutic Goods Administration (TGA) is charged with ensuring Australians can have confidence that the medicines and devices and other therapeutic goods that are sold in Australia and safe, effective and manufactured well. At a high level the role of the TGA is to practice evidence based medicine (EBM) and quality use of medicines (QUM). The last fortnight has seen poor outcomes on all fronts and both in the area of conventional and complementary medicines regulation.

In the first case a TGA proposed ban on combination products containing detropropoxyphene (DPP) was overturned by the Administrative Affairs Tribunal. DPP has been associated with death due to cardiac toxicity, albeit often in the situation of overdose. It is not considered to be a superior analgesic to common alternatives. Internationally the drug has been withdrawn from a number of jurisdictions because of safety concerns and available alternatives.

In the second case the vitamins giant Swisse has bypassed a ruling of the TGA that its’ diet pill does not have evidence to support its’ claims and has renamed the product and re-worded the claim. The product itself is the same. The registering process provides not oversight of this process and it can only be addressed through appeal.

Regardless of its’ best intentions in these cases the TGA seems hamstrung by the Act under which it operates. This is too the detriment of the general public and not in the spirit of the National Medicines Policy. In one case there is increased risk of harm without added therapeutic benefit, in the other little evidence of benefit. What is needed it not necessarily more onerous regulation but more thoughtful regulation and also education of the public, particular around complementary medicines.

These comments reflect my own personal opinion and not those of NPS Medicinewise.

http://www.smh.com.au/national/health/name-change-helps-swisse-sidestep-ban-on-hunger-product-20130411-2hokj.html

http://www.austlii.edu.au/au/cases/cth/aat/2013/197.html

Things they didn’t teach in medical school: Part 20 How to do meetings

So over the weekend I speed read Sheryl Sandberg’s book Lean In.

I was motivated by the useful summary by the NY Times David Brooks: “Think about Sheryl Sandberg’s recent book, “Lean In.” Put aside the debate about the challenges facing women in society. Focus on the tasks she describes as being important for anybody who wants to rise in this economy: the ability to be assertive in a meeting; to disagree pleasantly; to know when to interrupt and when not to; to understand the flow of discussion and how to change people’s minds; to attract mentors; to understand situations; to discern what can change and what can’t”.

This reminded me about something that is increasingly important in my life – going to meetings. In fact my colleagues give me a hard time because I’m a bit of a meeting junkie but this is only because they spend 4-5 hours a week in meetings as opposed to my 20.

If as a doctor you work in a hospital and you are engaged with the running of the place you will need to spend a lot of time in meetings. These range from meetings of 2-3 people to 20 or more. The reasons for the meetings will be diverse and they encompass education, environmental scanning (FYI meetings), working meetings (i.e. you are making decisions) and advisory meetings (where you are helping others make decisions).

There is a lot written about how to run effective meetings so I won’t re-iterate all of these writings. I will say however that you need to know what the purpose of the meeting is and at the end of any meeting there needs to be an outcome…a decision or an action arising. Bad meetings are staccato and without resolution whereas good meetings have ‘flow’ and resolutions. Meetings work when everybody who wants a say gets a say, diversity of opinion is expressed and the outcomes are determined by consensus (this doesn’t actually mean everybody likes the outcome but everybody agrees).

Overall David Brooks’ summary offers a nice approach to meetings.

One final thing you do need to know about meetings is when to say no….my rule is that unless it is exceptional there is no role for ‘routine’ meetings that happen only twice a year….almost by definition these don’t achieve anything.

There is a whole additional art to chairing a meeting – one which I’m just coming to grips with – and which will form another post.

Amazon Lean In

David Brooks The Practical University