Our rallying cry at ClickCare is: access, collaboration, and education. 

Sometimes, people are surprised to hear that medical education is such a core part of what we do.

The reason?  We've always felt that no solution within the medical system can possibly be complete or effective unless it also addresses medical education. Ultimately, there is no separation between excellent medical care and excellent medical education. So the fact that across medicine today, medical education is lagging so far behind innovations in the care itself is deeply concerning. 

As Marc Triola, director of N.Y.U. Langone’s Institute for Innovations in Medical Education said in a recent New York Times article, "the gap between medical education and real-world care has 'become a chasm.'" 

I’ll admit that reading this is deeply frustrating. There has been no time in human history when the gap between real-world care and medical education should be smaller. The tools and technology are there. And the need for excellent, powerful, progressive medical education has never been greater. 

This article makes the further point that in many ways, we don’t need MORE healthcare providers (despite the realities of what’s effectively a shortage), we need providers in the right places, doing the right things.

I do agree with that. But where we deviate is the premise that technology should be like a more vivid version of book learning — in which students use virtual reality googles or 3-D simulations to learn.

As we move into a rapidly changing future, our job is not to use technology to make a “fancier” version of how we currently do medical education or medical practice. Our job is to use technology to reframe how we learn, how we teach, and how we care for patients.

It reminds me of a quote from Richard Buckminster Fuller:

“I am enthusiastic over humanity’s extraordinary and sometimes very timely ingenuity. If you are in a shipwreck and all the boats are gone, a piano top buoyant enough to keep you afloat that comes along makes a fortuitous life preserver. But this is not to say that the best way to design a life preserver is in the form of a piano top. I think that we are clinging to a great many piano tops in accepting yesterday’s fortuitous contrivings as constituting the only means for solving a given problem.”

So many of the ways we use technology in medicine are simply using piano tops to solve today's problems. We use telemedicine to replace in-person visits rather than changing how we interact and collaborate as medical providers. And then we use technology to make a more vivid version of the old medical training, rather than reconsidering what's needed today. 

To me, the most interesting and powerful applications of technology and medical education are those that demand that training meet the most challenging aspects of care today. For instance, an inclusion of a more holistic view of the patient’s experience and what it looks like to care for them effectively. One example of this is a program at the Penn State College of Medicine where students serve as “patient navigators” after discharge from the hospital — giving them a sense of the complexities of coordinating care for patients in thoughtful, holistic, and adequate ways. Did that involve any expensive hardware or fancy tech?  No. But it did potentially evolve our students' capacity for working effectively on behalf of our patients. 

Similarly, we're passionate about using iClickCare to treat patients (via telemedicine and healthcare collaboration) but we also deeply believe in iClickCare's ability to support education through collaboration across the continuum of care (learning via the collaboration in each case) as well as the archiving of the collaboration process for each case, so that providers and students learn from key cases, even if they weren't involved at the time. 

Each and every healthcare provider has the responsibility of caring for our patients. But we also have the responsibility of training and leading the next generation of providers -- without that, our efforts don't build upon themselves.

See how telemedicine can help improve medical education by trying iClickCare in your practice and teaching:

As we’ve written about recently, the opioid epidemic is at staggering levels, and touching millions of lives every year in the US.

While these are complex cases, the truth is that treating addiction is not something that exists as distinct from treating any patient — since any patient can experience addiction. And a recent article in the New York Times put a spotlight on how our medical education may be failing to prepare doctors effectively to treat patients with addiction. 

The doctors, professors, and administrators in our medical education system are incredibly dedicated, and manage to adapt to a rapidly changing healthcare system. Some of the most satisfying work in my career has been my work with medical students and residents.

That said, there are always components of medical education that feel neglected, whether that's nutrition or alternative medicine. The care and treatment of addicted patients is no different, except for the staggering scale of the problem. In fact, addiction is contributing to 623,000 deaths each year in the US. And a new article explores whether our medical training is contributing to the shortcomings in how we care for these patients.

Realistically, the article documents what we're all aware of -- it's uncommon that there is sufficient training or support for doctors in caring for addicted patients. Most medical schools offer some training about opioids, but they rarely go very deep. New initiatives are aiming to create fellowships in addiction medicine -- but more trained fellows won't help the myriad of patients seeing providers in other fields who need solid training in how to care for them. But we also felt that some important perspectives were being left out of the conversation as represented in this article and the common ways of thinking about treating addicted patients.

5 things we know for sure about medical education and the treatment of addicted patients:

• Medical education can’t stop at graduation.
  It concerns us that the conversation about education around caring for addicted patients is understood to be limited to medical school. In contrast, we've always had three core principles at ClickCare: access, collaboration, and education. We've baked education into every single aspect of how iClickCare works, since we believe that medical education should be a lifetime goal -- both as teachers and as students. The opioid epidemic is changing rapidly over time and so our medical education has to keep up -- it can't get stuck in decades-old coursework. Allowing teams to archive and search cases for education (using a tool like iClickCare) is crucial to this process.
  
  
• "Problem patients" are everyone's problem. 
  All healthcare providers face different pressures. But we believe that when you decide to become a doctor, we believe that it's no longer ethical to see complex patients or cases as "not my problem." One of the suggested solutions to the training gap is to create "addiction medicine" specialists rather than increasing training around addiction for all doctors. Is specializing in addiction really the way to go?  Perhaps, all that does is let the rest of us off the hook for a very human dynamic that can happen to any patient and that we all need to be able to treat and recognize.
  
  
• We must teach each other.
  We have different strengths and weaknesses. And in an increasingly complex medical setting, trusted collaboration and complementarity is crucial. The care and treatment of addicted patients is a great example of why healthcare collaboration -- whether supported by Hybrid Store-and-Forward telemedicine or through another means -- is so important.
  
  
• Chronic diseases need special treatment.
  Addiction, like Diabetes, is a chronic disease. And patients suffering from chronic diseases need true care coordination, long-term collaboration within an integrated care team, and a truly team approach to their care. Addicted patients are no different, and we must find ways -- together -- of treating them as effectively as any other patient.
  
  
• There must be space for ambiguity. 
  As the New York Times article says, “although medical training typically urges students to come up with absolute answers, treating these patients often means getting comfortable with ambiguity.” Addiction is a delicate, nuanced challenge that requires providers to be able to handle ambiguity at an emotional and an intellectual level. That said, out tools must also be able to support and handle ambiguity. Rather than a text message which demands a succinct answer, telemedicine-supported medical collaboration allows more space for ambiguity because there is more space for nuanced conversations. Photos, videos, complex conversations, and multidisciplinary teams are all components of supporting complex care for complex cases. 

We know that many of you are "on the frontlines" of caring for patients with addiction every day. And we certainly hope that you're able to find the tools you need to evolve as a healthcare provider within that -- teaching, learning, and caring for patients.

To learn more about Hybrid Store-and-Forward® telemedicine, download our white paper for free:

Medicine, of course, is about far more than good decisions. It’s about compassion, leadership, science, and training. But excellent decisions — in both diagnosis and treatment plans — are absolutely crucial for providing excellent care. So I was intrigued to read an article recently, in my investment journal of all places, that made me think a lot about decisions and how we can make them better as healthcare providers.

The article, "Making Better and More Rational Decisions. An interview with Annie Duke," in the American Association of Individual Investors Journal, is a compelling piece with applications for life and investment, certainly. 

But what fascinated me were the implications for healthcare providers, trying to make the best possible decisions they can. Further, I noticed that many of Annie's points boiled down to getting better information or bringing others in on your decision -- both of which are deeply supported by hybrid store-and-forward telemedicine, when it comes to medical decisions. 

3 Fascinating Decision-Making Tips for Healthcare from Decision Expert and Pro Poker Player Annie Duke:

1. Remove emotion from the decision. 
We don't think about medical decisions as having an emotional component, but the truth is that they do. It's not unusual to get caught up in all of the details of a case, feel an emotional reaction to a patient, or otherwise let emotion creep into the decision-making process. Annie Duke says that predicting downsides is core to the decision-making process. And that predicting downsides is easier when you’re not emotionally involved -- which means that our colleagues' unbiased opinion is often crucial to a good decision. It's the reason that "bouncing an idea off" someone is such a common way to approach a decision -- but we have to have the tools in place to quickly and easily bounce ideas off colleagues, even when they're not just down the hall. That's what a consult via a telemedicine solution can do for you.

2. Bring in people with different experiences and views than you have.
That will lead to a better decision. “It’s especially important to seek out opinions that disagree with you. This is because we naturally notice things that do agree with us, and we already know why we think that way.”  Hybrid store-and-forward telemedicine is the most powerful way of truly engaging a team approach to telemedicine. Since you can quickly, easily, and asynchronously collaborate with people on the medical team across the continuum of care, it's not hard to bring in people with diverse experiences, views, and expertise than you have. These providers, who may not agree with your initial ideas, can help us make dramatically better decisions on behalf of our patients. 

3. Learn from past decisions. 
Learning from past decisions is crucial. It lets you take in new information, learn lessons from cases that didn't have the outcome you anticipated, as well as help our students or colleagues make better decisions by learning from our experiences. That's why every case in iClickCare is archived and searchable -- it's a realtime learning tool for making better medical decisions, now and in the future. 

Ultimately, good medical outcomes come from good medical decisions. These decisions may be large or small, but their sum contributes to the patient's outcome. So any tool that can help us make better decisions, may be critical to good care. That's one reason we're so passionate about our work with iClickCare -- and a reason to try it if you haven't already. 

Healthcare today is under such pressure that every resource we have seems in short supply. 

Time, supplies, patience, money, access to tools, and even patients all seem scarce at times, and many of us are under intense pressure to manage them. 

A recent article in the New England Journal of Medicine, however, used data to shed light on the question of what our most precious resource truly is... and how we might manage that resource more skillfully.In the April 19th, 2018 issue of the New England Journal of Medicine, researcher Graham McMahon, MD, MMSc looks at a set of data for residents' duty schedules. 

The primary purpose of the study, the iCOMPARE study of residents, was to compare two duty-hour schedules -- a more traditional set structure and a more flexible structure. 

The results seemed to indicate that overall, the more flexible structure was much more successful. But that depended a lot on the speciality of the resident (internal medicine vs. surgery, for instance). 

More interestingly, the author drew some fascinating insights from the study about how we value healthcare professionals: "Many healthcare institutions appear to have lost sight of the truism that our health professionals are our most precious resource.”  He also says that many healthcare professionals have lost the spirit of "volunteerism and soul" that has so animated our profession for so long. 

Specifically, he looked at how the shift structure affected burnout quite dramatically. In fact, just the change in shift structure resulted in more than 2/3 of residents reporting high or moderate levels of emotional exhaustion, depersonalization, and low perceptions of personal accomplishment. McMahon explains, "Burnout among health care professionals is generally attributed to work-related factors, such as overload, loss of meaning, and lack of autonomy, and ultimately affects many dimensions of care quality, including rate of error, patient mortality, teamwork, malpractice suits, patient satisfaction, productivity, and costs.”

But McMahon is careful to not imply that shift structure in itself is what needs changing. He emphasizes that regulatory expectations may need to differ across specialities and that training organizations should, above all, examine how they are:

• Funding and supporting educators and mentors
• Supporting and managing individual growth
• Providing sufficient time for electives and remediation
• Creating work environments that promote deliberate practice, reflection, and feedback without excessive clerical or clinical burden.

McMahon's most emphatic insight, however, is that healthcare organizations must prioritize people. He argues that the concerns and experience of healthcare professionals isn't a "side effect" or an ancillary concern -- these things are central and primary to the mission of those organizations.

This certainly resonated with our experience, as well. So many organizations spend huge amounts of time and money on complex hardware installations for projects like telemedicine, without really considering the usability and sustainability of the system -- they don't stop to consider people. It's assumed that provider schedules will accommodate videoconferencing, that people should be able to learn difficult interfaces, and that providers need to adapt to the project (not the other way around.)

Whether it is for telemedicine or training, our most precious resource is people. Not hardware. Not time. Not money. People. Because if the people are inspired, and trained, and allowed to work as a team, they will thrive and patient results will flourish. That's why when it comes to telemedicine, we believe organizations should spend less time and money on hardware and more time and money exploring the best workflows, interfaces, and simple tools to support people in working together in the ways that they want to.

So, choose systems and tools that acknowledge that people are important -- and that put people first in how those tools work and what they do. 

For a people-centric model of telemedicine, check out hybrid store-and-forward telemedicine: 

We work with a lot of colleagues on medical collaboration -- so we see the good, the bad, and the ugly. We help individual providers get set up with iClickCare; help hospitals learn to do medical collaboration; and guide practices in incorporating telemedicine.

And we've noticed extreme variation in which providers tend to do medical collaboration easily and effectively. Of course, our propensity for collaboration varies widely from one individual to another, very much not constrained by job title. But some provider types tend to embrace collaboration more than others.

So, a question for you: which type of provider do you think does medical collaboration best: the nurse, the aide, the patient, the family, the generalist, the specialist, the dentist, the allied health (PT, OT, counselor)?
You can consider the question from a personality standpoint, but don't forget that there are other influences, beyond the individual, which affect our ability to work together. The range of structural influences impact our ability to collaborate at a fundamental level: the insurance company, the managed care providers, the megalith healthcare system, the smaller hospital, the critical access hospital, the health department, the federal government, the VA, the legal system.

All of that said, we've noticed a very consistent answer to the "best" and the "worst" of how providers do medical collaboration: doctors tend to collaborate the worst and nurses tend to collaborate the best.

So why do nurses tend to embrace collaboration and physicians tend not to, at least at the beginning?

Well, nurses are often more collaborative by nature. Many nurses chose the profession because their personalities are supportive and nurturing. By day to day, minute to minute work, they get orders, execute orders and communicate orders. They are the people who get things done. They see collaboration as benefiting them because they can coordinate the many people involved in getting done what the patient needs done. They are salaried and held to production metrics, but less so than similarly salaried physicians. They are constricted by the same forces as physicians such as HIPAA, but by and large are free of contracts with insurance companies, managed care, and productivity reports. Their education reflects these factors.

I also reflect on the dynamic of differing medical education, in terms of the messages we receive around medical collaboration. Since doctors write orders, they are told that they “are captain of the ship” and therefore fully responsible for outcomes even if they are not directly involved in an action. With deeper pockets than nurses, and with this identification as “captain”, it is they who are the targets of the legal system.

The education of physician reinforces the mantle of responsibility. Most likely, the individual physician was taught on the first day of medical school, “Pay attention, learn everything, because the life of the patient is fully and solely in your hands. If the patient dies, it is your fault.”

That is a different role than advocacy that is often taught to nurses. “You are the keeper of the patient. You must advocate for the patient.”

So with doctors and nurses coming from such different starting points, think about the complexity that compounds as we add dozens of different types of providers to the mix -- and we expect them to collaborate on behalf of the patient. I look forward to hearing your stories and experiences of collaboration in the comments below -- every person, case, patient, and provider is certainly different.

As we work together, we need to remember that “none of us is as smart as all of us.” 

What if that were the first sentence we learned in medical school, or nursing school, or any professional school? What if it were then reinforced as we learn and work? We would all be happier - and healthier - for it. 

Read our Quick Guide to Medical Collaboration here, with stories of medical collaboration from around the world:

'A couple of weeks ago, I had the pleasure of reconnecting with a remarkable man -- a former attending, a mentor, a friend. As healthcare providers sometimes do, we started talking about interesting cases. 

We had a patient who was a vibrant 15 year old girl, on the swim team, and suddenly couldn't walk, I told my friend. We feared the worst, as did her parents -- advanced spinal or brain tumor was a very real possibility. Every day, even every hour, is important. In addition to not wanting to delay any necessary treatment, we also didn't want a busy high schooler out of class for weeks on end. That said, four specialist opinions were needed, from different health centers, and all with visit waiting lists of months. We were lucky enough to have iClickCare available to us, and in seconds we had securely shared a video of the girl's issues and a brief request for consult with all of the specialists. Within hours, three physicians weighed in on their opinions and appropriateness of referral. Semi-emergent surgery was scheduled and a good outcome obtained. The entire workflow was accomplished without interruption (the specialists could respond as easily as posting to Facebook, and on their schedule) and without scheduling a video clinic visit. The system saved thousands of dollars. Everyone won -- the patient, the doctors, the system, the secretaries.

Our friend listened carefully, and as I finished describing the outcome, his eyes lit up and he exclaimed, “Great Case!”

There is a lot of satisfaction in hearing that. It means that you, the provider, did something a little unusual, made a good diagnosis, participated in an ideal outcome, shared worry and success with colleagues and peers, and even managed to appease the looming demands of cost containment.

Of course, as a busy provider, I didn't have time to do anything special with the case once it was resolved. But without needing to do anything special, the case was stored, the pictures, video, and data were all stored, and I've used it as a teaching case countless times in the years since. I'm able to reference it -- and the hundreds of other cases that have been stored in the course of regular care -- and students can learn from them. The student can learn about the pathophysiology, but maybe even more importantly he can learn by reviewing the discussion. It is there that judgement, approach, analysis can be saved and later revealed.

This type of real-world learning is more important now than ever because modern medical education has changed. The 80-hour work week provides rest (although this is not being shown as beneficial for patient safety as was once thought). Testing is more prevalent, participation is less. Current education does not allow for the absorption of the subtle discussion that constitutes continuity of care. It does not show or teach the interactions and give-and-take that are so important in healthcare collaboration and care management.

Indeed, it seems as if we have been thrust back to 1910 when Abraham Flexor reviewed the abysmal state of medical education and suggested a framework for improvement.

The combination of attitude, work hours, financial constraints and EHR/EMR conspire to give the student the same deficiencies as Flexor saw in 1910. Instruction is didactic and wholly textbook, memorization without innovation. Students don't touch the patient often. Much of clinic time is tied up in EMRs. At a few minutes per patient, there is little time to allow the student to think, to fail in the thinking, to be corrected and to think again. Working by shift amplifies these deficiencies. Research funds are shrinking. Continuity of care and care collaboration are not part of this process.

All of that said, we don't believe that fixing these issues need to be a matter of waiting for the whole system to change, or even overhauling all of medical education. In fact, we've found that using hybrid store-and-forward telemedicine, like iClickCare, can create opportunities for individual healthcare providers to change medical education, 5 minutes at a time. Since Hybrid Store-and-Forward® technology, all collaborations/consultations are stored, we can see how things unfold, and any case can become a "Great Case."

So, our proposal (and yes we recognize the magnitude of this -- it took decades for Flexor to see change) is that each medical student starts the first day with a way to record and participate in “Great Cases”. A note enriched with video, pictures and PDFs of data is made as a dissection progresses, an X-Ray is read, a lab finding is discussed. By collecting the information and by participating in the process, under supervision, lifelong learning and a love of same can be developed.

And that means that the satisfaction of sharing and learning, and the reward of providing truly good care all add up to more and more Great Cases.

You can try iClickCare for medical education for 2 weeks, absolutely free. Just click here for your trial:

Photo from wocintechchat on Flickr, used under Creative Commons rights.