Posted on | September 16, 2014 | No Comments
This morning I was sipping my coffee as I reviewed the latest news in the New York Times on my iPad. And, of course, the Top News was depressing – ISIS, Ray Rice, Ebola and so on. So I found my way to the video section and looked around a bit.
I ended up taking a careful look at three entries. Having spent some time in media, and judged more than a few medical media award contests, I have a certain approach to these things which includes a non-judgmental quick viewing followed by a second review that more critically deconstructs.
The three pieces I focused on all fell into the broad science and technology education bucket, and all arguably had a connection to either the human patient or planetary patient or both. The shortest was 2:04 and the longest 6:36. One used a standard, broadcast-tested, interview style backed up by B-roll and liberal use of ambient sound. A second relied on simple, stylized moving graphs. And a third utilized visually stunning and highly creative paper cut-out constructs brought to life through manual animation and stop action photography.
Despite the difference in styles, all three were highly successful in holding the viewers attention, delivering complex messages, and tying those messages to future action. All three had the benefit of a musical score, though only one used an original score that was credited. All three had clearly taken care in their choices for voice-overs or on screen commentators. And all three demonstarted extraordinary discipline in limiting word count and labelling, allowing the pictures and the voices and the music to largely guide the reader.
The 3:04 standard broadcast piece, “Formula E, Carbon Free” was created by Jonah M. Kessel. But the real star of the show was a young Chinese racing driver, Ho-Pin Tung, representing “China Racing” and a generation of young tech-savy global leaders with a passion for technology-aided advances in the human condition. Oh, and by the way, the guy is great on camera – a terrific spokesperson for the movement.
The movement is Formula E, a series of urban, Formula 1 style racing events that kicked off in Beijing’s “Olympic City” on September 13, 2014, and will be traveling to nine other cities around the world over the next 12 months. In a little over 3 minutes, the viewer comes to understand that these high performance vehicles are electric and run on batteries; are intended to both entertain and act as laboratories for green development; and that the future is just around the corner.
As the visually appealing Ho-Pin Tung says in perfect English with just a few well-chosen words: ““As in the past, racing has always been proven to be a laboratory, a development center for new technologies needing to be developed for general use in cars. This series is going to only accelerate this. It won’t just accelerate the development, but also the interest of people in electric cars.” He goes on to explain that the low carbon footprint of the event allows it to be staged in center city settings, where pollution is extremely problematic and solutions are imperative.
Finally, the piece uses two black text boxes with white print to catch your attention. Neither one preaches. The first says, “Formula E race cars reach 60 m.p.h. in less than three seconds and have a top speed of about 140 m.p.h.” And the second, “The Formula E championship will continue on to nine cities across the world over the next year.” Take-away? “Stay tuned for the next installment.”
The next piece, “How It Happens: El Nino” is a 2:04 moving graphic narrated by Henry Fountain and produced by Aaron Byrd, Henry Fountain and Ben Laffin. It is a simple, attractive, well-designed and effective short lesson on how weather happens and how these forces impact our lives, and potentially our health. With comforting narration, and simple music to fill the dead space, all eyes are on the graphics which are so simple, clear and concise that they require little labeling. As a result, the imagery is clean, uncomplicated and easy to digest. We learn in a little over two minutes what El Nino is; that it causes dramatic weather effects around the globe; that there are Pacific Trade winds that push ocean water along and, in doing so, push warm water out and allow cold water to rise to the surface; that warm surface waters increase moisture in the air and promote monsoons; that sometimes the Trade winds stop (we’re not sure why) and the direction of the changes reverse; and that this can cause warmer winters in our Northwest like the one that created the snow-less Winter Olympics in Vancouver in 2010.”
And, with the help of extraordinary instructional design, they do this in 2:04 without the viewer feeling rushed.
Last, but certainly not least, is “Animated Life: Seeing The Invisible”, a 6:36 highly visual, puppeteer-driven tour de force. Using paper cut-outs, with visible animation aids in the form of wires and navigating sticks, with or without moving cinematic painted backdrops, all made more lush by the original score of Sarah Lipstate, this piece introduces us to 17th century scientist Antonie van Leeuwenhoek, who with the aid of homemade microscopes, discovered microbes. Beginning with stingers of bees and legs of louse, and advancing to pond scum alive with miraculous creatures 1000 times smaller than the scientist had ever before visualized, we are escorted through history. Along the way, we learn, for example about the luminescent Vibrio Harveyi. As narrator Bonnie Bassler from Princeton voice-over explains, “We discovered that bacteria can communicate using a molecular language. We used to think that social behaviors were the purvue of higher organisms. What we now understand is that the bacteria were probably the first organisms on this earth to ever communicate with one another.”
In each of these cases, there is a request stated or implied. We understand that we are invited to attend a Formula E race “in a city near you”. It’ll be exciting, and fun, and it’s a worthy movement that could help our planet. We’ll also be on the look-out for El Nino. What weather surprises are in store for you and your neighbors this year? Stay tuned. And finally, we are all under the microscope. As Bonnie Bassler gently intones, “We’re driven by our ignorance and driven by the idea that the world must be more complex than what we understand right now. And that’s enough inspiration to do an experiment.”
For Health Commentary, I’m Mike Magee.
Posted on | September 11, 2014 | No Comments
Each year, the memories of 9/11 offer the opportunity to reflect on the principles that guide our human populations in the direction of good and evil. Several years after the event, I delivered an address that laid out a philosophy of leadership grounded in lessons learned that day. Here is the address.
Posted on | September 9, 2014 | 2 Comments
This week, a study, from the Department of Psychiatry at the UC Davis Health System, offered hope to parents of children with autism. The small study of seven children revealed that intervention begun at six months of life resulted in improved outcomes at three years of life. The children included “exhibited marked autism symptoms, such as decreased eye contact, social interest or engagement, repetitive movement patterns and a lack of intentional communication”. Six of the seven caught up with normal peers by three years of age.
Hinsdale Family Medicine Program, during RCP home visit.
I read the study with special interest considering my role as executive director of the Rocking Chair Project. The effort has partnered with Family Medicine residents around the country who were able to identify economically disadvantaged moms about to give birth, and were willing to do a home visit within 3 weeks of delivery. Where does the rocking chair come in? It is a vehicle for nurturing. The residents train to assemble this gift onsite in the home while sharing concrete information and strategies designed by early childhood experts at “Zero To Three” including the importance of holding, soothing, gazing, engaging and comforting newborns.
As Edward Zigler, PhD Professor Emeritus at Yale has said, “The younger the child at the time of the intervention, the larger the payoff to the child. There can be no relationship without real proximity in which the interaction is characterized by warmth and concern. That’s the Rocking Chair Project.” Harvard’s Professor Emeritus, T. Berry Brazelton adds, “What a wonderful project – to provide rocking chairs for every mother so they can rock and soothe their babies.”
Within this context, what caught my eye in the latest report on the UC Davis website was the authors explanation of the training intervention offered to the children in this study. According to protocol:
“Parents were coached to concentrate their interactions on supporting their infants’ individualized developmental needs and interests, and embedded these practices into all of their play and caretaking, focusing on creating pleasurable social routines to increase their children’s opportunities for learning. Parents were encouraged to follow their infants’ interests and subtle cues and gauge activities in ways that optimized their child’s attention and engagement. The intervention focused on increasing:
Infant attention to parent faces and voices
• Parent-child interactions that attract infants’ attention, bringing smiles and delight to both
• Parent imitation of infant sounds and intentional actions
• Parent use of toys to support, rather than compete with, the child’s social attention
The treatment sessions included:
• Greeting and parent progress sharing
• A warm-up period of parent play, followed by discussion of the activity and intervention goals
• Discussion of a new topic, using a parent manual
• Parents interacting in a typical daily routine with their child while fostering social engagement, communication and appropriate play, with coaching from therapists
• Parents practicing the approach with their child across one or two additional home routines with toys or caregiving activities”
My immediate reaction was three fold:
1. Isn’t this “intervention” simply good parenting? Shouldn’t every child born to loving parents expect this type of treatment from day 1?
2. Is the incidence of autism higher in children deprived of these natural forms of loving engagement with their parents? What are the various causes for parental disengagement independent of socio-economics- competing interests, post-partum depression, lack of knowledge or insight, empathetic deficits etc.?
3. If there is a causal relationship between early parental disengagement and autism in a newborn, should risk identification and preventive intervention be targeted at parents in the pre-natal and immediate postnatal period, as is the case with the Rocking Chair Project, rather than delaying intervention until 6 months of age or later and targeting the child, and cooperating parent?
While this new study offers desperately needed hope, it implicitly sidesteps the question of a causal link between ineffective, non-empathetic parenting from birth and autism, while at the same time suggesting the resolution of the devastating symptomatology associated with the diagnosis can be achieved through a regimen of deliberate, active and empathetic parenting. This is a contradiction that begs further study and clarification.
For Health Commentary, I’m Mike Magee
Posted on | August 28, 2014 | No Comments
Julia Belluz created the infographic below to compare how much money is donated to fight various disease and how many people in the USA die from those same diseases for an article in Vox.
Read more HERE.
Posted on | August 18, 2014 | No Comments
DDT spaying beach area, 1950's
In tracking the events in Ferguson, Missouri, last week, I was reminded of the words of environmentalist, Edwin Way Teale, some 70 years ago, as WWII was drawing to a close. That war, and arguably the Allied success, was the result of our ability to mobilize and redirect the enormous productive capacity of America’s institutions toward creation of materials that would directly or indirectly support our success.
One unintended consequence, as we learned last week, is that the weapons of war, once the war winds down, sometimes leach their way into the domestic stream of life. And generally, the two don’t mix very well – practically or metaphorically. In the recent case, the image of a heavily armored vehicle cradling an equally heavily armed and crazy eyed sharp-shooter, in the middle of a small Midwestern town is jarring.
But this is not the first, nor I suppose the last time that our Military-Industrial Complex, in pursuit of “peace-time” profit has morphed in front of our eyes. Which brings me back to Teale, who in 1945 was already a well known naturalist author who began his writing career with Popular Science magazine. In March of that year he wrote an article in Nature on DDT titled “DDT: The insect-killer that can be either boon or menace”. In the article he recounts the military use of the insecticide developed for the war effort against malaria carrying mosquitos in the South Pacific. He describes the effort as another front of the war (man versus bug) that was waged with great enthusiasm, a “bug-blitz binge” deposited by “lackwit officials” as he describes it.
What motivated Teale to write the piece at the time was a conversion he was witnessing that was well underway already in the homeland, even before we had a Homeland Security Department. Faced with a surplus of the chemical produced by Monsanto and others, surplus armored vehicles and planes, and a surplus of airmen, the solution pushed by industry, and endorsed by the US Department of Agriculture, was to aerial and land spray the insecticides on America’s farmland, beaches, marshes and woodlands. Teale cautioned about the“unexpected by-products…when man tries to interfere with the balances of Nature… [out of] our ignorance of the interrelationships of natural life.”
While the warnings were prophetic, they went largely unheralded, as the “after-the-war” planes (as Teale called them), piloted by former military pilots sprayed up to 500 acres an hour with chemicals produced by Monsanto and others. In fact, in 1956, when I was 8 years old, I found myself in the vicinity of our own “bug-blitz binge” when the USAD approved the spraying of a million acres of Northeast forests in the hopes of eradicating the gypsy moth.
Edwin Teale died on October 18,1980. For fifty years he labored to deliver primary source material on the environment to the American public. He earned many awards, including a Pulitzer-Prize, but his life was not without controversy. His long term, and well-documented professional friendship with Rachel Carson, author of Silent Spring, and his willingness to challenge broad and indiscriminate spraying of DDT in non-emergency situations, created a point of contention for major chemical companies, their trade organizations and their governmental and academic dependents at USDA and land grant universities over the years.
Their tactics were to make Rachel Carson (during her life and even after her death) the issue, not the chemicals they were indiscriminately distributing around the globe at substantial profit margins. And so it is with Ferguson, where the tragic death of Michael Brown (and the public affairs battle to diminish his reputation) or the debate surrounding the police officer involved, recalls the public debate surrounding Teale’s wartime battles over whether insects were “good, bad, or indifferent”.
But like then, it’s not about the insects, its about the chemicals and the profiteers. And – without denying in any way or diminishing the importance of addressing America’s continuing struggle with racism, or the unconscionable daily denigration, incarceration, and destruction of young black men in this country which cries out for immediate justice – for me the most important issue is that the “Military-Industrial Complex”, and arguably a former Halliburton CEO vice-president, helped get us into this mess, and then created the Homeland Security Department, which, along with the US Military themselves, came up with the brilliant idea of transferring weapons of war to ill prepared small towns and borderline competent police departments across America.
Edwin Teale’s words, “A spray as indiscriminate as DDT can upset the economy of nature as much as a revolution upsets social economy. Ninety percent of all insects are good, and if they are killed, things go out of kilter right away” is instructive. The vast majority of the people in Ferguson, MO, are good. But the indiscriminate distribution of what are clearly weapons of war can also “upset the economy of (our human) nature as much as a revolution upsets social economy.”
Homeland Security and the US Military (likely with the active support of Industry) got us into this mess by “militarizing” America. US citizens should expect nothing less now than that our President and the Congress force these very same bodies to demilitarize America, and pass legislation that will protect all of us from having this ever happen again.
For Health Commentary, I’m Mike Magee
Posted on | August 13, 2014 | 2 Comments
An editorial in this week’s New England Journal of Medicine asks, “Is it Time For A Tobacco-free Military?” The article nicely summarizes the arguments for (few) and against (many) the promotion of cigarette tobacco on bases, in the commissaries, and on the battle field. It also lays out accurately that previous attempts to create a cigarette free military have been blocked by Congress, whose members were responding to Tobacco company lobbyists. What the article does not do is lay out the historical use of the military by tobacco interests to seed and addict new users (and subsequently their families) and to wrap their product in the American flag while claiming health benefits for their deadly product.
I smoked my first cigarette in the Spring of 1957 at the age of 9. My brand of choice was “L&M”, not based on the quality of the tobacco or any emotionally based brand loyalty, but because they were accessible. My parents kept a carton of them in a corner cabinet in the kitchen. They were light smokers, primarily lighting up with a cup of coffee after dinner. So a carton could last a long time. And believe it or not, you could sneak out one of the ten packs and they wouldn’t even notice it.
By then, there were 10 of us with my brother Steven, number 11, due that September. Having snatched the pack and stuffed it in my pocket, I cajoled my older sister, Pat, and my younger brother, Dan, into joining me and we headed out the back door into the protective woods and weeds that formed the center island of Abbott Boulevard. Here we were well hidden and secure, able to figure out together for the first time how to light up, breathe in the burning smokey air, and expel it in paroxysms of coughing. It wasn’t pleasant, but it was a necessary ritual if we expected to grow up.
It’s unlikely that my father smoked L&M’s during the war. Instead he probably relied on Camel’s or Lucky Strikes, depending on what was available. The war years were tense, a fact of life that didn’t escape tobacco marketers. They sold the message hard and wrapped it in the American flag.
For example, one wartime print ad included a collage of paratroopers in a plane, an individual soldier, and a woman sewing a silk parachute in a wartime factory. The header read “YOU WANT STEADY NERVES to ‘hit the silk’ in a paratroop attack.” The text begins, “ ‘JUMP’ is the command that starts you on that headlong earthward plunge through space, but the real order of the hour is ‘steady nerves’. For these soldiers of the sky – for every one of us! So take a tip from the men on the front line.Their favorite is Camel – the slow-burning, mild cigarette. Make Camel your cigarette, too – starting now!”
The soldier is eye to eye with the reader and couldn’t agree more. His text bubble, “YOU BET I SMOKE CAMELS. THEY’RE EXTRA MILD AND THEY ALWAYS TASTE GREAT.” Below him, in small print, next to a military 3-D star, the reader finds evidence: “With men in the Army, the Navy, the Marine Corps and the Coast Guard, the favorite cigarette is Camel. (Based on actual sales records in Post Exchanges, Sales Commissaries, Ship’s Stores, and Canteens.)”
Not to be forgotten, the woman factory worker – eyes on the job as she diligently labors alongside her sister workers, sewing those parachutes by hand with tight, even stitches – comments, “ ‘I HELP MAKE THOSE PARACHUTES’, says Helen V. Lynch, Pioneer Parachute Company employee, ‘And I can tell you nerves don’t go in my job. Smoke? Yes, I enjoy smoking. I smoke Camels. They have the mildness that counts and Camels don’t tire my taste.’ Yes, for all of us – front line, factory, farm, whatever your task – this is a ‘war of nerves.’ More important than ever, now, is your choice of cigarettes. Smoke Camel.”
Another Camel ad from the same vintage prefers shorthand and heavy branding. The ad is bright yellow. The box of Camels is set diagonal and drawn in 3-D on the upper two-thirds with the famous camel and the notation, “TURKISH & DOMESTIC BLEND CIGARETTES”. The message, short, sweet and bold on the lower third, “CAMELS – SMOKE AS MANY AS YOU WANT…THEY NEVER GET ON YOUR NERVES!”
In the post-war period, infusing values, limiting anxiety, and relieving depression, were continually referenced in code. “Camel gives you honest enjoyment, clean-cut taste, easygoing mildness. Moments seem to brighten up every time you light one up”, reads one ad. Along the same line, a post-war Lucky Strike ad features a smiling, cheerful woman handing a cigarette to her grimacing, angry-looking husband whose back is turned to her, with the out-of-sync and somewhat unnerving message, “To anxiety…I bring relief. I’m your best friend. I am your Lucky Strike.”
By 1957, my father had plenty to be anxious about. But why “L&M’s”? The answer likely can be found in one of their ads at the time which featured the actor Frederic March. (In another version, the actress Rosalind Russell is featured). The header says, “L&M FILTERS ARE JUST WHAT THE DOCTOR ORDERED!” In the body of the ad is a picture of the actor saying, “When I read Dr. Darkis’ letter I tried L&M filters. I’m really enthusiastic about them. They’re a wonderful smoke – with a filter that really does the job.”
For validation, the ad includes a copy of Dr. F.R. Darkis’s letter. Turns out, Darkis was actually a chemist not a medical doctor. He is listed as “Director of Research” for Liggett and Myers Tobacco located at 450 Fifth Avenue, New York, NY. The letter reads,
“Extensive investigations of possible filter media were initiated in our laboratory and by our consultants early in 1951. The search continued until a strictly non-mineral material was found that effectively filtered the smoke. This is the material used in “L&M” filter tip cigarettes and is a highly purified health cellulose. Pure white in color and used as an additive in certain foods, it is entirely harmless to health.
Alpha cellulose is the purest material now available to filter cigarette smoke. It removes over one third of the smoke without impairing it’s satisfying taste. The ‘L&M’ alpha cellulose filter is specifically designed to remove the heavier particles from the smoke stream leaving a truly light smoke.
When you smoke ‘L&M’ cigarettes made and guaranteed by Liggett and Myers Tobacco Company, you draw into your mouth much less smoke with much less nicotine and other nitrogenous constituents.”
For my father, the “EFFECTIVE FILTRATION” bannered on the top of each pack must have been reassuring, as well as the non-harmful nature of “alpha cellulose”, and the claims that it weeded out nicotine and harmful nitrogenous particles. Both my mother and father seemed to enjoy a good smoke, and did it it with a certain amount of flair and sophistication, especially at the dinner table on Sunday afternoons, with all of us sitting around focused on dessert while they sipped their coffee.
As for me, I was OK with stealing from the family stash, and I liked sharing the illicit catch with my siblings. But honestly, that first experience was not a pleasant one, and so I didn’t immediately get hooked. But eventually I did, and from my late teens through surgical residency, I did smoke when I had the money to buy cigarettes. I only stopped when my wife threatened to divorce me (I think she was kidding but was never certain), in my fourth year of surgical training.
What I did like, even as a child, was the aesthetics – the red and white, clean and clear design of the package, the compact container with 20 identical cigarettes standing tightly, side to side, the appearance of smoke sifting off the tip of this small fire stick, and the idea of “coming of age” smoking. In this regard, I tended to align with William L. Dunn, a PhD in Psychology from Duke and “Principal Scientist” in 1972 at Phillip Morris. Another one of those doctor look-alike’s, he waxed poetic with these observations: “The cigarette is among the most awe inspiring examples of the ingenuity of man. This cigarette should be conceived not as a product but as a package. The product is nicotine. The cigarette is but one of many package layers. There is the carton which contains the pack which contains the cigarette which contains the smoke. The smoke is the final package. The smoker must rip off all these package layers to get to that with chiefly which he seeks. Smoke is beyond question the most optimized vehicle of nicotine and the cigarette the most optimized dispenser of smoke.”
For Health Commentary, I’m Mike Magee
1. Spiegel A. The Secret History Behind the Science of Stress. July 7, 2014 http://www.npr.org/blogs/health/2014/07/07/325946892/the-secret-history-behind-the-science-of-stress
2. Cummings KM, Morley CP, Hyland A. Failed promises of the cigarette industry and its effect on consumer misperceptions about health risks of smoking. http://tobaccocontrol.bmj.com/content/11/suppl_1/i110.full
3. Gardner MN, Brandt AM. “The Doctors’ Choice Is America’s Choice” : The Physician in US Cigarette Advertisements, 1950-1953. American Journal of Public Health. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470496/
Posted on | August 8, 2014 | No Comments
It’s been quite a week for the “Medical-Industrial Complex”. This interwoven series of governmental, non-profit, academic and corporate relationships rivals the countries “Military-Industrial Complex” in its relentless consumption of America’s human treasures and financial capital, its’ non-transparency, its’ capacity to resist reform in an orderly and responsible manner, and its’ wide range of coordinated lobbyists in support of an unholy alliance of players.
This week, we witnessed President Obama’s attempt to break through one historic pillar of the Medical-Industrial Complex, the VA health care system. Viewed properly for practical purposes as a near wholly owned subsidiary of the major Academic Health Systems, this reliable governmental funding stream has been a bulwark of graduate medical education, faculty procurement, medical technology and medical research. AHC’s have been happy to have the asset since the active partnership was first proposed in the immediate post-WWII period. It has served them well. As for the vets – not so much.
This last scandal – one of many over the past half century – was apparently the last straw for the President. His plan includes the usual bump in funding and proposal to expand human resources which, as in the past, will be sucked into the system and rapidly disappear without trace of patient benefit. But in addition, in a matter similar to the injection of charter schools into the nation’s broken public education sector, the President allowed for the first time for vets whose care is delayed or is poorly matched to need to opt out, and seek care at the public’s expense from non-VA hospitals of their choice. This for the first time will have the effect of challenging the AHC-VA system and its non-performance based revenue stream. While only a start, it suggests that in the future the money will follow the vet, rather than the other way around.
In a similar attempt to break the status quo, a second pillar of the Medical Industrial Complex shook at its base this week with the release of an IOM report on future funding of GME. As the report states, “Since the creation of the Medicare and Medicaid programs in 1965, the public has provided tens of billions of dollars to fund graduate medical education (GME), the period of residency and fellowship that is provided to physicians after they receive a medical degree. Although the scale of government support for physician training far exceeds that for any other profession, there is a striking absence of transparency and accountability in the GME financing system for producing the types of physicians that the nation needs.”
The report proposes that:
Federal GME funding be maintained at about $10 billion a year with Medicare the major source for the next decade.
The Office of the Health and Human Services Secretary create a GME Policy Council and a new GME Center to guide and administer the new system.
Separate funding streams for direct and indirect costs of GME disappear and with it the history of gamesmanship. In its place would be an Operational Fund to support existing GME programs, and a new GME Transformation Fund to support innovation and equitable distribution of physicians throughout the country (a stated priority for the past five decades that seems no further along today than when it was originally flagged).
GME payments would no longer be pegged to Medicare inpatient days, the resident to bed ratio, and other factors. Rather there would be a flat per-resident amount (PRA) with some (hopefully few) geographic adjustments.
PRA funds would actually go to the institutions doing the education, not automatically to the teaching hospital for disappearance into a general operating fund. Educational institutions, Community Health Centers, or GME consortia could all qualify.
Between the two events this week, we see an attempt to break through the status-quo. Both carefully avoid a frontal attack on the Medical-Industrial Complex whose financial and political assets are formidable, to say the least. Rather, each in its own way offers a third way. In the case of the vet, he or she has the option to opt-out to a non-VA hospital, which ironically in many cases could be that VA hospital’s sponsoring AHC university hospital system. In the case of GME, OK we’ll let you continue to draw down the federal budget for another 10 years, but you’ll be capped. And during that time, as a measure of good faith, you will participate in the building of a new performance based system that will supplant the system you fought so hard to defeat in 1965, but learned to love so well.
As Eli Ginzberg so perceptively observed in his 1990 book, The Medical Triangle, “Over the twenty-year period from 1946 to 1965, academic medicine was totally reshaped. Only the medical school curriculum…remained relatively unchanged.”
The resultant Medical-Industrial Complex has effectively resisted change ever since. And yet – America, and the needs of her citizens, have continued to change nonetheless. As Ginzberg laid out 25 years ago, the challenges for GME were real and remain largely unaddressed.
In his words:
“They will need to hone problem solving abilities and understand the role of uncertainty in medical decision making; to gain access to, and to use effectively, the ever larger pool of medical information, which means acquiring computer literacy; to talk to patients and even more important, learn to listen; to develop a greater understanding of the role of the physician in today’s society; to be sensitive to the moral and ethical issues that affect responsibilities toward the medical system; to have the technical competence to practice medicine; and to continue training to keep abreast of the expanding knowledge base and the technology of medicine.”
“…tertiary care hospitals have become increasingly inappropriate sites to carry on the larger part of their clinical training. Many patients are being worked up before admission; diagnosis related groups have shortened the number of days that patients spend in the hospital; and much of the treatment that once went on in the hospital is now performed in ambulatory settings. Medical schools need to identify ambulatory settings in which to carry out much of their teaching function.”
With such pressing and chronic needs, it hardly seems unreasonable these days to be asked to perform if you wish to be paid.
For Health Commentary, I’m Mike Mageekeep looking »