Friday, April 15, 2011

Thoughts after two days of a primary care conference

I haven't seen a patient in 10 years, but I like to keep in some contact with my first career. So I've spent the last two days at the MAFP Spring Refresher. It's inexpensive and local and the lectures are comparable to most such conferences.

Mostly I enjoyed the presentations, but I'm not going to write about those. Instead of commenting on the "new" discoveries, I'll comment on the static and the transitory.

What's static is the manner of presentation. In the past 30 years we've gone from transparencies to (yech) PowerPoint, but the basic format of medical lecturing is unchanged. The most interesting material is only spoken, not written. We get lists of symptoms (near pointless) instead of typical and atypical presentations. We don't hear enough about common mistakes. We rarely get frequency or prevalence data or diagnostic sensitivity, specificity or positive predictive value. Even experienced clinicians don't describe natural history of the conditions they know. We see lists of moldy textbook treatments that the speaker would never actually lose herself. Specialists don't tell us what makes a good referral. We get nearly worthless PDFs (that we can't copy/paste), only one speaker (the best) provided a handout of key points.

Thirty years -- and we've made no real progress in something as fundamental as person-present education.  Since improvements are so obvious (see above) this is a curious form of market failure.

What's transitory is medical practice. Medical progress is almost as static as medical education, but I was struck today by the effervescence of medical fashion. Perhaps it's a side-effect of a field that now changes slowly, but several speakers spoke of national care guidelines that seem to reverse direction every two years. I think of daily and monthly changes to medical practice as being like the weather in Minnesota - frequent storms that rage and thunder -- then pass slowly away. Against that is the climate of slow change and true progress, but that now takes a decade to see ...

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