Our least favorite type of research is the observational study. Think: eggs are good for you, eggs are bad for you; eat meat, don’t eat meat; statins cure everything, statins cause everything; and on and on.

However, observational studies can be a first step into deeper understanding. An example is Jenner’s observation that milkmaids who contracted cowpox did not get smallpox. In the current "publish or perish" environment, the necessary deeper inquiry (Jenner tested vaccination, albeit in a crude way as we look back) often does not happen. Public media grabs and grasps the story, disseminates the story, and the story disappears and is gone within less than 24 hours. Another publication is notched for institution and researcher. Big data is thanked. Rarely do we find someone who goes on to ask why.

Certainly, inquiry into what works and what doesn't is extremely valuable. That said, two recent studies also beg for a deeper answer. Both are by the same author. The first study by lead author Yusuke Tsugawa observes the female physicians have fewer patients die or be readmitted. They speak of adherence to clinical guidelines  and “patient centered communication." 

The second study concludes that younger physicians have fewer patients die while the readmission rate is the same. It pits older physicians against younger physicians. Medicare patients formed the sample. Policy implications concluded that medical education and its maintenance of certification is important.

There is no doubt that the younger physician is a better coder and understands the value of coding maybe even over outcome. Could this be the education that is required? 

But, let’s not quibble over reasons and explanations. Above all, what matters most is how we can improve medicine. 

Assume the conclusions are correct, and that there are indeed differences born of gender and age. Why not encourage, support, and demand collaboration and communication? Bring the old to share with the young, the young to teach the old. The style of the female to mesh with the style of the male.

Regardless of whether these studies are strong and solid and show true causality between these physician demographics and their outcomes... Why not work together, rather than focus on controlling the parts?

These stories of medical collaboration show that you can take outcomes into your own hands:

Doctors have different motivations for going into medicine. Some do it because they thrive on the intellectual and emotional challenge. Some because they have an altruistic desire to help people ease their medical problems. Some seek power. Others go into it because it seems stable, prestigious, and potentially well remunerated. Most, in my experience, do it because of a combination of the challenge and the altruism.

These different motivations create different actions and priorities in day-to-day care.

For instance, as Dr. Mikkael Sekeres describes, doctors who prioritize control or power can overreact when patients as for a second opinion. (I will say, though, that supporting second opinions is a nuanced thing -- from time to time, the inappropriate pursuit of multiple opinions will actually subvert, rather than support, the patient's health goals.)

We've frequently seen this with providers who use -- or don't use -- iClickCare. You can often predict the administrators and providers who embrace this collaboration tool.

Those who embrace telemedicine and collaboration are motivated by good care, not power or financial reward.

(Although, ironically, both power and financial reward seem to come from innovating and collaborating.) Those who embrace it are willing to take a risk (just the risk of having tried something.) Those who embrace it see their colleagues as friends and allies rather than as competitors.

In the same way that Dr. Sekeres believes that opening oneself to second opinions is part of being a good doctor, we believe that opening oneself to collaboration and technology is part of being a good doctor in 2015 and beyond.

No one of us is as good as all of us. And for those of us who want to be truly good at being a medical provider -- that means that collaboration is essential.

To learn how telemedicine and collaboration can help you give patients extraordinary care, click here: 

We love bringing you news of innovators in healthcare, like this PA clinic or that project to encourage collaboration. Another story about an innovative initiative raised some questions for us, however.

The New York Times covered the trend of religiously oriented groups organizing health "networks" in which members contribute payments to cover each other's health expenses. As health insurance has become federally mandated, these groups are complying with federal law, but in a way that feels personal, affordable, and enables them to circumnavigate pieces of the law that don't align with their values. 

We get excited when we hear about projects like this. We firmly believe that when regular people get more involved in their healthcare, we all win. Plus, we leap for joy whenever a small group of people find a way for common sense to win out over healthcare madness. It's pretty fantastic that when Erica Beiler gave birth, her expenses were covered and members even sent extra money to help welcome the baby into the world. 

That said, we could never -- as people or as providers -- support the network since things like medical care to gay folks and treatment for STDs aren't covered. It's certainly not a system that aligns with our ethics. Plus, the networks are unregulated, often have a lifetime maximum payout, and there may not be enough money on hand in a given month to cover all eventualities.

Be that as it may, we still are happy to shine a spotlight on a small group of people doing something, taking action, to make the medical system work for them. You may not be a patient or provider that would take part in a network with these parameters, but it does raise the question: how are we taking action, today, to make the medical system work better? How might we take matters into our own hands?

We believe medical collaboration is one easy, fun way to change the healthcare system. Give it a try for free: 

Image courtesy of holtsman on Flickr, used under Creative Commons rights.

As a former college football player myself, I can understand the desire of athletes to play hard, hustle, and not let an injury keep them from the game. That get-it-done approach has served me well, on the sports field as well as in the operating room.

The NFL has long been a bastion of this kind of ethos. For many years, when NFL players got a concussion, they were tossed back into the game, told they got "dinged." And the players were often part of the problemas well; Ronnie Barnes, the Giants' SVP for medical services remembers locking players' helmets in a trunk to keep them from going straight back into a game.

But there is an increasing awareness of the negative short-term and long-term consequences of brain injuries, including disabling chronic traumatic encephalopathy. This is evidenced in part by the law suit for hundreds of millions of dollars brought by 5,000 former NFL players about NFL handling of hits to the head. For NFL players, and for the league, getting a hard hit is no longer something to be taken lightly.

Now, the NFL has created an exhaustive, and seemingly sincere, strategy to keep players safe and manage concussions when they do happen. The approach, chronicled in an inches-thick manual, includes specially trained head-injury spotters that patrol the game from high above the field. It necessitates that several providers ring in on a "go/no-go" decision for the player to return to a game after a hit to the head. And it requires waiting periods and a series of visits with a neurologist once a concussion is diagnosed.

What is fascinating about the protocol is that it leverages medical collaboration as a tool to make sure the best decision is made for the player. As the New York Times reports, "It features a broad cast: a head-injury spotter in the press box, athletic trainers on the bench, doctors and neuro-trauma specialists on the sideline, and experts in neuro-cognitive testing in the locker room." After a single bad hit, many people contribute their perspective on what they observed and whether the player is "acting like" he got a concusssion: referees, other players, the team doctor, athletic trainer, head-injury spotter, and a neuro-consultant may all have a voice in making the determination.

Some players or coaches may feel the protocol goes overboard in systematizing a medical decision that isn't that complex. Others may feel it doesn't go far enough. But one thing for sure is that the NFL's approach leverages the power of medical collaboration to keep players safe. When different providers are enabled to work together to share their perspectives -- whether from their speciality or from their vantage point on the field -- better decisions are made.

Here's to using your perspective to keep your patients happy, safe, and in the game as much as possible.

Image courtesy of yourdon on Flickr, used under Creative Commons rights.