The Daily Sign-Out

Medscape Interview with NIH Director

Medscape recently produced a fascinating interview with Dr. Francis Collins, Director of the National Intitutes of Health that focuses on genomics but ranges broadly over several areas, including medical education and preventative medicine.  It's not that long and there is also a text format if you don't want to watch the interview.  Highly recommended.  This a thought-provoking interview.

I think Dr. Collins is overly optimistic about the impact of genomics on day-to-day patient care.  Pharmacogenomics, for one example he uses, has not made any impact thus far in my experience.  While it is a tool, perhaps, for demonstrating why a patient may not be responding to a particular drug, the use of pharmacogenomic testing before initiating treatment has not been prospectively studied to my knowledge in any trials, for any drug.  This leaves aside the further studies regarding cost-benefit analyses as well as the issue of payment/reimbursement.  Right now, it seems cheaper and tried to put a patient on a standard dose and see what happens.

Another example is the idea of genomic sequencing of cancers.  It sounds good because it provides a "personalized" profile of a cancer.  What about tumor heterogeneity?  Do we sequence the primary tumor or metastasis?  Which part of the primary tumor?  Which metastasis?  Finally, how does one compare "unique" tumor genotypes and develop groups to statistically compare treatment responses?  At some point, patients have to be lumped together (and thus muddying up personalized differences) in order to find appropriate guidelines for treatment and provide some prognostic information.

Lots more to think about!

Analyzing Malpractice Claims to Reduce Errors--a pathologist's perspective

The Informed Patient column by Laura Landro from yesterday's Wall Street Journal (September 27, 2010) has an interesting report entitled, "What the Doctor Missed" which discusses how analysis of malpractice claims is informing efforts to improve medical practice.

The issue of diagnostic errors due to missed or delayed diagnoses should be of particular interest to pathologists.  The article doesn't explicitly state this but poor communication (patient-to-physician, physician-to-patient, PCP-to-physician/specialist, etc.) seems to me a major factor in lawsuits and a major contributing factor in diagnostic errors.  How can we more effectively communicate our findings to non-pathologists?  I especially note reference the article makes to breast cancer.  We routinely use histological diagnostic terms--that can have crucial implications for patient care with respect to appropriate follow-up and risk assessment--which can bewilder even experienced surgical oncologists and radiologists.  An example from breast cancer would be communicating the spectrum of "columnar cell lesions."  If we identify this in a core biopsy for a mammographically-detected abnormality, do we routinely communicate any assessment of risk for concomitant or future cancer?  Is that the responsibility of the pathologist?  In a broader view, what is our responsibility in ensuring that physicians "receive" actionable lab results?  Can we design systems that can prevent errors "of omission" that result from missing critical lab information within a critical period?  A blogpost isn't sufficient space to devote to an in-depth discussion of these questions but the problem is more complicated than just mere documentation.

This is just some appetizers for consideration.  I wonder if one of the subjects we are missing in medical school might be communication (i.e., rhetoric and semiotics)--not just making PowerPoint presentations but I'm talking about how to talk to people (all different kinds of people), how to assess what they've heard or understood, and (perhaps most critically) how to listen.

James Fowler on the Power of Social Networks

I referred to the book, Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives, by James Fowler and Nicholas Christakis, in my recent lecture at SIU's Symposium on Teaching and Learning.  I've been thinking about the implications of this book with respect to medical education and how to incorporate these findings into teaching strategies.  This video podcast is a nice introduction of the book by one of the authors, James Fowler.
PopTech : popcasts.

Using social networking for pathology teaching

I had the privilege of presenting yesterday at the "1st Annual Symposium on Teaching and Learning" at Southern Illinois University-School of Medicine in Springfield (my alma mater!).  I am uploading a pdf of the slides from the presentation.  This is my (very!) preliminary experience from last fall teaching the organ-specific  lung section of the second-year pathology course at Rush Medical College in Chicago using a course blog (Lung Sounds) and Twitter profile (@lungsounds) to enhance the traditional curricular format of textbook, lectures and course syllabus.

It is interesting that there was not more participation on either the blog or Twitter.  One of the comments in the discussion is that Twitter may not have yet caught on in the med-student age group.  Maybe.  Another was that the students may need more "hands-on" in-class development of groups before migrating to social networking groups.  One suggestion was to have break-out small groups discuss a simulated case prior to the formal lecture presentation.  This is a work-in-progress.  I am considering using a Facebook course page for a proposal next year that would incorporate the ideas behind the blog/Twitter.  An M2 student I spoke with has informed me about Google-Wave which has some interesting possibilities.  Anyone else using social networking sites in their teaching?

Download SIU presentation--Pool