Aug 27, 2010

Statistics in baseball and medicine

I went to a baseball game with my father last week (go Sox!). Our pitcher wasn’t doing so great – his strike rate was hovering around 50%, and it was taking him almost twice as many pitches to get through an inning. I knew this because my dad kept pointing out statistics – live, updated – on the board. And that was a simple statistic, calculated as I watched. But they only got more complicated. I began to envision a gigantic database in my head. They reported the number of errors a player had made while in that position (so the database must have a field for position played). Then the number of times a pitcher pitched a strike when there was a full count (the database must have not just the number of balls and strikes, but the order). I was very impressed. But then I realized it couldn’t be that hard to design a good, if complex, database. I mean, they’re doing it for baseball.

But then I went back to work the next day. I’m a grad student doing health care quality research. We’re trying to answer a relatively simple question about medications and laboratory monitoring. Little has been reported on this information before because almost no one has even more basic data on prescribing rates and test ordering rates. Besides, prescribing databases are unreliable because patients may not fill the prescriptions, while claims data isn’t always reliable because some people pay out of pocket, for example. So we can’t answer simple questions like how many people got appropriate monitoring tests to better target interventions and improve care, much less the complex ones.

Imagine if we had the stats of baseball in health care. Imagine what we could do. Which is more important?

Aug 26, 2010

Lessons from Bo Schembechler

My second year of medical school is off to a great start. I applaud the psychological considerations that went into making cardiology our first sequence of the year because I've never been so alert in class. It's no surprise now as to why so many people want to become cardiologists--the electrophysiology, pathophysiology, and the pharmacology of the heart is awesome stuff!

Because heart disease remains the number one killer of Americans, the scientific advancements in the field and the amount of potential in uncharted territory in regards to genomic and vascular manipulations to cure disease are astounding. Only at the University of Michigan would we have a lecture about the legendary football coach, Bo Schembechler, to illustrate the complexities of managing heart disease and the scientific advancements of the last forty years that have made living with heart disease a possibility.

Bo Schembechler coached the University of Michigan Wolverines football team from 1969-1989. He led the team to 13 Big Ten Conference titles and holds a career record of 234–65–8. I don't really follow football, so I'm going to focus on his medical narrative.

Every time Bo Schembechler had a coronary event, starting from his first heart attack at age 39, a new scientific therapy was available to him:
Taken directly from Dr. Kim Eagle's slides

Bo Schembechler needed all of these new treatments. It is not uncommon to find a patient these days who is managing heart failure, hypertension, hypercholesterolemia, arthritis, and diabetes all at once. What makes Bo Schembechler a remarkable case study is how his disease course outlines the history of how we manage cardiovascular disease. His life was changed tremendously with each scientific advancement. Bo Schembechler is not just a University of Michigan story, but a medical success story that anyone who has ever spent time with a biochemistry textbook dreams about.

The Bo Schembechler medical narrative doesn't stop there. The lessons we can learn from him extend far beyond the biomedical disease model. Extending his coaching career into his health, Bo realized that an integrated team of health professionals who practiced patient-centered care was the best play in the game of achieving a healthy life. As Dr. Eagle describes:
    He had an integrated medical team. He chose his doctors based on whether they communicated well with him and other physicians. He said to me, "I want to go to a doctor who makes me feel that I am their only patient at that time. If they are looking at the computer or writing; they ask me two questions and then say see you later, then they are not on my team."
Bo believed that he was put on this earth to build young men. He may have built over 500 young men through coaching football. But just through listening to Dr. Eagle's account of what it was like to be Bo Schembechler's cardiologist, Bo was coaching people all around him to be better people all the time. Here's what Dr. Eagle said about what he learned about the practice of medicine through Bo:
    ...a lot of times, we rush through. And modern medicine rewards that. More RVUs, more revenue, less personal touch. So one of the challenges you will have is to do that. You will have choices. You will have choices to see more patients and make more money, or see fewer patients and connect. I would argue that modern medicine can never take the professionalism away. Only you can give it away. If you choose to, you can. But don't. Resist that temptation. Design your professional life so that you can connect. Because most of you came into this because you have a yearning to have that connection. To get paid to hep people is an amazing gift. But, to focus on helping them requires discipline.
Much to my college football loving cousin's chagrin, I don't follow college football at all. I sadly didn't even make it to a single University of Michigan football game at the Big House last season. The Wikipedia article about Bo Schembechler can catch me up on all of his sports accolades. Perhaps it's because I'm a medical student with a bent for quality improvement, but the Bo Schembechler, Heart of a Champion medical story is so much more meaningful. It's not easy to find a case that is as interesting clinically as it is in regards to health care delivery all in one. But, Bo Schembechler does just that. He's another reason why I'm happy to be at the University of Michigan.

Aug 22, 2010

IHI Open School at the General Assembly of the IFMSA

Dear all,

from the 31. of July to the 6th of August I participated at the 59th General Assembly of the International Federation of Medical Students's Associations in Montrèal, Canada. Over 600 medical students from all around the world took part in the event, and a lot of them got to learn something about the IHI Open School.

IHI Open School had four of it's Chapter members present in Canada, and together with a prospective Chapter Leader from Trondheim and Anthony Gifuni from the local Montrèal-Chapter we were able to promote the Open School day and night. =)

IOS-Oslo gave an introduction to Patient Safety to the participants in the Standing Committees on Medical Education (SCOME) and Human Rights and Peace (SCORP), and the OS was presented at the Regional Meetings of the Americas, Asia&Pacific and Europe.

A regional Chapter-event was held on the 3rd of August, and 32 students participated in that event, and the feedback we got was very positive. There is a growing interest of health system improvement and patient safety among health care professional student's all over the world, and hopefully we'll come together and learn through the IHI Open School-network.

The next IFMSA General Assembly will be in Jakarta, Indonesia in March 2011, hopefully there will be someone representing the Open School there too =)