Priorities for 21st century family medicine research

Hinweis der Redaktion

1. Welcome everyone. Congratulations to the residents! Let’s have some fun!
2. Residents have just finished some hard work. You’ve dipped your toes into research. For some of you the water felt really cold! Let’s spend some time this morning at a higher level. After all, why would you ever want to be involved in research down the road???
3. So, let’s start with a question... makes sense for a research talk... The world map is a clue... Here’s another... Why did Columbus think he was in India when he got to the island of Hispanola? Here’s another... This problem was costing millions in lost ships and shipping. Next slide will tell you how important this was to the Royal Navy...
4. That’s a lot of money! Last clue. The timepiece in the picture was part of the answer.
5. The problem was “Longitude.” Explain... This guy solved it when the scientific elite couldn’t.
6. So...why am i telling you this story? Is there something here that we can learn?
7. Today we take it for granted. We pop on our GPS, and we never imagine what it took to breakthrough the “common wisdom” Because in the 17th century the “common wisdom” was 1st: the answer is in the sky And 2nd, the common wisdom said you could never build a clock that would keep accurate time at sea. Ships rock for heaven’s sake! How can you run a pendulum on a ship?
8. Perspective can limit our thinking, Or, it can open up our thinking... to new possibilities In medicine today, we can use all the new possibilities we can get
9. This is where we, the family doctors, come in. Our perspective is different from the perspective of mainstream medicine THAT MATTERS! So, what characterizes our perspective???
10. We take care of patients over time. We know patients before, during and after their illnesses. We know them as more than their disease. We have a relationship with them. How is this different? I think of a patients of mine, who I’ve diagnosed with cancer. Yes, I refer them to oncology, but none of them have ever stopped needing a family doctor, needing me. During and after their treatment. That’s a different perspective.
11. We don’t have the luxury of just treating the heart disease, or the diabetes, or the depression. We treat all of it. We see how they interact. We understand intuitively that our patient, Ms. Jones, is depressed because of all of her illness burden. We swim in complexity. That’s different. Single disease oriented evidence, from patients that have all their other co-morbid conditions selected out, doesn’t speak to what we do.
12. Just like we can’t see diseases in isolation, we can’t see our patients in isolation. They are in relationships, families and communities. Those relationships, families and communities matter. I think about Mr. Smith. He is a type II diabetic. He was well controlled until his wife died. Why did his diet suffer? Not why you think! That’s a different perspective. His endocrinologist kept trying to change his dosing. She needed to understand the context. It wasn’t his meds. It was his church ladies!
13. Over the years we’ve put our Family Medicine perspective to good use. In some cases we’ve changed the standard of care. Some of this obvious now. Sometimes we are successful. What are we up to now? What should we be up to?
14. Here’s a great one from your own Dr. Kondrad. She asked a great question. We are doing a study to try to answer it.
15. Here’s one that lot’s of people are asking. Should a care manager live in a practice? Or can they sit in an office somewhere else, and just make phone calls. Hospital administrators think the answer is obvious. What do you think? We’re applying our unique perspective to challenge the “obvious.”
16. (read the question) The answer is obvious, right? We’re pouring money into investigating serotonin receptors in the heart, and all kinds of fun stuff. Is it so obvious? Is it the disease or the burden of not just heart disease? We applied our perspective and found the common wisdom was wrong.
17. In order to apply our perspective, we need good labs. We have great “potential” labs. We need to understand them as labs. Places with data waiting to be recorded, analyzed and understood. PBRN’s are a big part of this. PBRN practices get that they are labs. We want them to see that in their communities as well. We are learning how to connect practices to their communities, so they can ask questions together. That brings yet another perspective into the mix. And that’s good!
18. We also have to understand our tools.
19. Card studies are a great tool for observation. We use them to understand what is going on, with PCMH, with MMJ, with CT’s and headaches
20. We do clinical trials. With practices. What if you train some practices to do chronic disease management one way and others get trained another way? We do trials in the real world. Because it still takes way too long to get evidence into routine use.
21. We dig deep. “ Not everything that can be counted counts, not everything that counts can be counted” To understand we sometimes have to talk to people, do detailed observation, map out the workflow. You did this for the lab project.
22. We’re also learning how to do observational studies using EMR data. Not easy work, but we are getting better at it. We are also learning how to use HIT to do trials.
23. My belief... It’s going to take all of these tools to solve the triple aim. Reduce cost, improve quality and improve patient satisfaction It’s going to take a bunch of rubes like us, practicing and working outside the fancy observatory on the hill.
24. We know that the perspective of this place...hasn’t gotten us very far.
25. So now, as you are just at the start of your careers, it’s time to start asking yourselves... What’s my perspective? What “common wisdom” doesn’t fit with my perspective, doesn’t fit with what I’m seeing. (next slide)
26. If you can ask those questions, you can help find the answers. Maybe you feed the question to your PBRN. Maybe you decide to participate in finding the answer to others’ questions by taking part in a PBRN study. Maybe you think asking and answering questions is fun. In that case, we need to talk more!
27. Remember this. Remember your perspective matters. Ask questions. That IS the future of Family Medicine research.