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Social Media May Be Better Than Tests And Credentials At Identifying Good Doctors

I am consistently bemused by those who recommend more rigorous or more pervasive standardized testing as the primary means for insuring physician quality. The vast majority of physicians have already passed through a complex gauntlet of multiple choice exams, extended credentialing and certification processes, and lengthy tests of knowledge and skill. And yet, some physicians (to put it bluntly, sorry friends) are very bad at what they do.

Intellectual intelligence is necessary, but not sufficient, for doctoring. It is emotional intelligence (EI) that is sorely lacking – because it has neither been cultivated, nor selected for, by many training programs. Some educators openly acknowledge the problem, pointing to “extra-curricular activities” as their primary means of distinguishing equally qualified applicants. The disappointing reality is that non-academic performance may be a tie-breaker for students with similar standardized test scores, but raw scores almost always trump any other factor. In the end, we have a physician work force that is highly adept at assimilating and regurgitating facts, but is only accidentally good at human interactions.

Is there hope for change in this arena? I believe that the prognosis is guarded. As our culture becomes more and more digital data-driven, a tsunami of “meaningless use” threatens to drown us all in false quality measures, electronic medical record documentation “quality assurance” requirements, and analysis of trends without comprehension of context or influencing variables outside the scope of the measuring instruments. Lies, damn lies, and statistics. We can’t get enough! And guess who are the biggest proponents of these methods? Why, people who only excel at standardized testing – mostly because their true flaws also lie outside the measuring instruments. Bad doctors (sometimes turned-administrators) themselves are often fueling the onslaught of fruitless quality improvement initiatives.

Dr. Howard Luks, orthopedic surgeon and social media activist, wrote a provocative blog post on the subject of why physicians don’t engage more in social media. He suggests that many avoid it because they lack people-skills in the first place and don’t genuinely enjoy engaging with patients. If you’re a “jerk” in real life, he argues, then what advantage is there to making that more obvious on blogs, Facebook, Twitter, etc.? Better to stay socially quiet.

The interesting thing is that social media might be the most reliable way to discover whether or not your doctor is kind, thoughtful, observant, and detail-oriented. Reading a physician’s thoughts online can help you get to know their true personality and work ethic. In the future it would be nice if medical schools and residency training programs took the time to read applicants’ blogs (for example) instead of crunching their test scores for admission via the path of least resistance. An extra hour of reading up front could save our medical system from a new wave of low EI providers.

As Seth Godin put it, “Uncaring hands are worth avoiding.”

We all recognize the importance of this statement intuitively, but have a hard time quantifying “caring” with standardized tests. That’s why admissions officers and patients alike must use their judgment when selecting doctors. We pay verbal homage to the importance of “clinical judgment” in medicine but in reality are culturally afraid of straying from numbers to support our decision-making.

How will you know a good doctor? You’ll know him [or her obviously] when you see him. And sometimes you can see him best on social media platforms.

***

A few caveats of course:

1. Social Media is a sensitive but not specific test. Meaning, you can probably accurately identify caring doctors from their blogs, etc. but if they don’t have one, it doesn’t mean they aren’t good/caring.

2. It may not matter if you find a great doctor online if they’re not in your limited ACA network. :-?

3. Direct primary care is a potentially excellent way to get connected to exceptional doctors. I am a fan of this movement and have been actively involved in a practice in VA. The practices can reduce costs and enhance quality care, though recent caps on Health Savings Accounts (initiated by the Obama administration) have reduced consumer freedom to spend pre-tax income on direct primary care.

A Video Poem: Medical Tests And What “Normal” Means

I’ve written a few times about Veneta Masson, a nurse practitioner who wrote in Health Affairs and the Washington Post about her decision to forego further mammograms despite the fact that she was in a higher-risk category.

Veneta is also a poet. She sent me a video animation of her poem “Reference Range,” which I’m pleased to share with you. I think the poem and the video are beautiful, touching on important issues of how meaningless numbers and scores may be, subject to misinterpretation. She writes:

I see no cause for alarm.

“Is it normal?” you ask.

Normal’s a shell game you seldom win.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Why A Good Childhood Isn’t About Good Grades

Spring and standardized school testing become synonymous in many areas of the country for many public school students, including for my own children attending schools in Massachusetts.

As this annual rite of passage rolls around, I’m reminded of how important it is to help our kids remember that they’re so much more than the sum of their grades, test scores, and project results. Think back on your childhood: What do you remember? Is it the grades, the teachers, the homework amount? Did you have standardized tests and, if so, do you remember the results?

I recall blips of taking tests and filling out scantron sheets for all sorts of tests throughout my educational life. I recall being in class when graded papers, projects and tests were handed back to us. But the moments I recall the most were the times I overcame a challenge or a hurdle that seemed insurmountable at the time — and grew from it in unimaginable ways. Read more »

*This blog post was originally published at Dr. Gwenn Is In*

Should Medical Schools Require Personality Tests For Admission?

Currently, the most important test prospective medical students take is the Medical College Admission Test, or MCAT.

Despite what schools say, an MCAT score holds tremendous weight, more so than a brilliant essay or a stellar recommendation letter.

In an interesting New York Times piece, Pauline Chen wonders whether that score itself leads to a great physician. She discusses an article showing that students’ cognitive traits may be equally important.

Although students go through several interviews to get an assessment of their personality, these are rarely standardized, and certainly not quantified. It’s important to know, for instance, how a student responds to stress: “If I know someone is not just stress-prone, but stress-prone at the 95th percentile rather than the 65th. I would have to ask myself if that person could handle the stress of medicine.” Read more »

*This blog post was originally published at KevinMD.com*

All Teens Under Pressure To Be Above Average

My heart is going out to teens these days, especially in my high-achieving community. It seems school districts and parents alike have lost the sense that “average” is really OK, and in some cases, much healthier than “above average.”

An emotional goal of adolescence is to answer the question “who am I” acquiring self-certainty as opposed to self-consciousness and self-doubt. Most teens approach life expecting to succeed and achieve their goals rather than being paralyzed by feelings of inferiority. On a normal path, adolescents seek out people who inspire them and gradually develop a set of ideals and goals for their future. This is all perfectly normal, and if all goes well, teens become young women and young men who believe they can do whatever they set their minds to and are willing to work hard enough for. This process gets stunted if the expectations set for them are unreasonable. Read more »

This post, All Teens Under Pressure To Be Above Average, was originally published on Healthine.com by Nancy Brown, Ph.D..

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