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November 2007
Evidence-Based Tip
Report from AAMC: Our Changing Values
I write our EBM Tip this month from Washington, DC, where I am attending the AAMC Annual Meeting. What better place to see modeled the professional values exposed and modeled than from those to whom we entrust the education of our future physician? If you will allow me, I would like to depart from my usual subject area to share with you some of what I am hearing here.
The theme of this year's meeting is "Health in the Balance," and many of our leaders speak of a change in our healthcare landscape, in our cultural values, and in our ability to provide what is needed for our patients. The common thread, the underlying connection, is the need to balance the needs of our individual patient with the health needs of all of our citizens.
Dr. Darrell Kirch, AAMC President, spoke of the change in our culture. Where competition, hierarchy, individual excellence and the respect for expert opinion may still be the dominating values, we are moving towards a different way of achieving excellence. Transparency-where how decisions are made and how dollars are obtained and spent-is our new value. Specialized teams are replacing the individual caregiver, where continuity of care replaces becomes the new value. Patient-centered care, outcome focused care, and collaborative care become our new institutional values. Our reward system shifts from recognizing personal achievement to recognizing the ability to network, to collaborate, to create and work in healthcare teams.
Our values in the research arena are shifting as well. AHRQ Director, Dr. Carolyn Clancy, spoke on the need to focus on reliability instead of achievability. Where as we now pride ourselves at the incredible medical miracles we are able to provide for the few, we need to balance that with the time, effort and funding we put towards "getting it right" for the all the patients all of the time. She spoke of systematic reviews conducted by her agency to set standards for quality of care, and the need to build clinical information systems that access these standards at the point of care.
Perhaps most evocative was Dr. Daniel Federman, a senior dean at the Harvard Medical School, and the only speaker to receive a standing ovation. He described the need for medical education that is "intellectually dazzling, emotionally gratifying, and morally transcendent." He demanded a curriculum that invokes disgust, outrage and shame at the inequities and lack of care for so many of our citizens. He was asked by a reporter what would happen if his students could not practice the way they were taught, when his way of teaching did not match the world that his students faced. "Then," he replied, "they will have to change the world."
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Laura Cousineau, MLS
MUSC Library
Dept. of Pediatrics EBM Faculty |
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