“Physicians already know all too well the burdens and harm that can occur when insurance company impose prior authorization requirements,” TMA President Diana L. Fite, MD, said. “Our lawmakers need to do more to make sure our patients get the medicines, tests, and treatments that they need, when they need it.”
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This piece was originally published in the January/February issue of the Tarrant County Physician. You can read find the full magazine here.
Dr. Bailey presented this speech at the AMA’s House of Delegates on November 13, 2020.
In my inaugural address to the AMA House of Delegates in June, I talked about how a hero’s journey is symbolic of the journey we walk as physicians.
Our journey starts with a moment of inspiration to pursue Medicine. We find a mentor to show us the way. We encounter struggles and hardships before emerging stronger and more resilient . . . forever changed by the experience.
Few times in history have we embodied the hero’s journey like we have in this past year. In June I talked about Harry Potter, Star Wars, and The Wizard of Oz . . . but much of the last few months have felt more like the dystopian world of The Hunger Games.
COVID-19 has brought immense challenges and pain for so many—including our physician community. We have struggled mightily at times. Many of us know a colleague who lost their life to COVID-19. Many of us have fallen ill, or we have watched a family member or loved one battle the virus.
We have done things in 2020 that we could not have imagined . . . shining a spotlight in an uncomfortable place—on ourselves—as we repeatedly cried out for more protective equipment to keep us and our patients safe.
For the financial aid to keep our struggling practices afloat.
For the information and resources to make sense of it all. To provide counsel for our patients. To better understand what we were up against.
As we greet the new year 2021, the pandemic feels a little different now.
We don’t know if it is the end of the beginning . . . or the beginning of the end. But we are a bit wiser and a bit tougher than before.
“As with every hero’s story, we must learn from the trying times we have experienced. We must grow and move forward because that is what a hero is asked to do. “
We don’t know everything about the journey ahead, but there is plenty we do know.
This year has shown us the best in physicians and our health care community—the nurses, assistants and staff personnel who are always by our side.
Who are in the trenches with us even in the most difficult of times . . . and that understand the importance of physician-led teams.
But this year also has revealed how politics can be corrosive . . . how misinformation and anti-science rhetoric can impede our ability to respond in a health emergency and can magnify the cracks and inequities in our health system.
Nine months into our fight against COVID-19, the pandemic is as dangerous as ever. We have reached record highs and surges continue across the country.
We have learned in this most difficult year that no person and no community is safe from this virus. It reaches everyone . . . no matter their background, their income, or their politics.
And yet, in face of this pandemic—perhaps the greatest threat to public health in our lifetimes—physicians have heroically answered the call.
Time and again, through surges and plateaus, working under intense pressure and at great personal risk, our physician community has risen to the challenge of this moment.
We have done this with courage and with selflessness because of our singular dedication to our patients’ health.
And now, with a new year ahead and possible vaccines on the horizon . . . we are about to make a fresh start. Change is in the air.
Never again can we allow the politics of division to undermine our ability to deliver the very best care to our patients.
Never again can we allow anti-science bias and rhetoric to undermine our public health institutions . . . and discredit the work of physicians, scientists, and researchers.
Never again can we allow a campaign of misinformation and disinformation to co-opt conversations around public health . . . and sow divisions that only serve to prolong the suffering of so many.
Never again can we allow public health officials to feel the pressure of threats and intimidation simply for doing their jobs.
And especially when lives are at stake, never again should physicians have to fight a war on two fronts—caring for severely ill patients in a raging pandemic . . . while at the same time battling a public relations war that questions the legitimacy of our work and our motives.
This is unacceptable . . . and we will not and cannot continue to work in this atmosphere.
While we have seen the best of physicians in 2020 . . . we were reminded again of the power of the AMA, the TMA, the TCMS, and of the entire Federation community working on our behalf and being our voice when it mattered most.
Our organizations created tools and resources—all grounded in credible science and evidence—to help us respond to this historic crisis.
We pushed the administration to accelerate production for testing and PPE. TMA and TCMS kept our practices supplied with life-saving equipment.
Our medical organizations helped establish a financial lifeline for struggling physician practices, securing tens of billions of dollars in financial support, grants, and interest-free loans to infuse practices with much-needed capital to survive this pandemic.
Organized medicine was a leading national voice in support of science, evidence, and data as the surest path through this pandemic, launching a major public health campaign to encourage everyone, everywhere to “Mask Up.”
All of us should be proud of how organized medicine has stood up for physicians this year.
As with every hero’s story, we must learn from the trying times we have experienced. We must grow and move forward because that is what a hero is asked to do.
That is what physicians are expected to do.
That is what we expect of ourselves.
All of us are eager to see an end to this pandemic. And with encouraging new reports about vaccines nearing approval, there is tremendous excitement about what the new year will bring.
But we are not there yet. All of us need to continue to do our parts. We need to constantly remind everyone to wear masks, wash hands, and physically distance. We need to remain steadfast and focused until the very end.
We should not underestimate the fight in our opponent. Every time we feel like we have COVID-19 on the ropes, here and abroad, we see it roaring back.
We have to remain strong and follow where the science leads us.
The next few months will be buzzing with anticipation about the post-COVID world that will emerge.
Regardless of when that day arrives . . . and when normalcy returns, whatever that will look like . . . our AMA, specialty, state, and county societies will play a critical role in shaping the health system of the future.
A system that ensures that everyone has access to the affordable and meaningful coverage they need.
A system that relies on science, evidence, and data to guide our approach to public health and prevention.
A system free of the historic barriers to care . . . and ensures that all patients stand on equal footing.
A system that supports and integrates a revitalized public health infrastructure.
A system that protects the patient-physician relationship from outside influence at all costs.
And a system that prioritizes physician health and wellness . . . and eases administrative burdens that take us away from what we do best . . . caring for our patients.
Despite the challenges of this past year, and they have been extraordinary, I continue to believe in the power of organized medicine to fix the persistent problems in our health system.
I believe in science and evidence to light our way.
And I believe in the strength and resolve of physicians to take on any challenge . . . and rise to any moment.
The hero’s journey is our journey. And we are exactly where we are meant to be.
This piece was originally published in the January/February issue of the Tarrant County Physician. You can read find the full magazine here.
I can brag on myself as I have been involved with medical education for over 40 years now. Thirty-seven of those years were spent working as an assistant and then an associate professor of medicine at the Texas College of Osteopathic Medicine (TCOM) within the University of North Texas Health Science Center. I was the first full-time gastroenterologist there. I left private practice in Dayton, Ohio, where I was adjunct faculty at the Ohio University College of Osteopathic Medicine. I wanted to be more involved in medical education than that position offered. So why am I telling you all this? So you know that I have been around a long time and have seen a lot of changes, including monumental ones in medical education, from the classroom to clinical bedside clerkships.
UNTHSC developed an Academy of Medical Educators where physicians, other health care providers, and basic scientists at TCOM have learned and discussed the theories and principles of medical education including Bloom’s educational approach and Miller’s framework for assessing clinical competence.
After we learned the fundamentals, we now concentrate on other aspects of medical education. One of the of most significant changes that has transformed how we educate is that we no longer “lecture.” Indeed, it is now considered a four-letter word—lecturing is seen as passive learning. Also gone are reading assignments from textbooks. Other forms of education now rule the roost. This includes online education and interactive forms of learning.
So, what is so wrong with textbooks? About 10 years ago, I read a letter to the editor in the New England Journal of Medicine, where two second-year UCLA medical students calculated the total number of pages assigned by instructors for one semester. A staggering 10,000 pages were assigned and were fair game when testing occurred at the end of the semester. Too much? Yes!
A recent Google search stated the doubling of medical technology in 1950 was 50 years, in 1980 seven years, in 2010 three and a half years, and in 2019 one and a half years. Now in 2020 it is 73 days; not even three months. I recently told this to a fourth-year medical student on my service and as his eyes widened, he exclaimed, “That’s scary!” So, to revisit what is wrong with textbooks, here it is: The editors work with other experts to write a designated chapter, all work is edited and corrected, it is then published, printed, distributed, and purchased, etc., etc. This whole process takes years. So how many times has medical technology doubled in that time frame? Educators still refer to textbooks, but as references, not as primary education material.
A man walks into a bar in New Orleans and asks for a Corona and three hurricanes. The bartender hands him the bill—$20.20. Yes, the COVID-19 pandemic has changed things, possibly permanently. Virtual medical education is the current modus operandi. Zoom, WebEx, Skype, and Join.me, to name a few, are the classrooms today. Right now, learning clinical skills is generally virtual. Inconceivable but true—not hands on but virtual patients. Not entirely new, just brought to the forefront due to the pandemic.
Over the past several years, the lecture (that four-letter word again) hall has been sparsely filled unless attendance is mandatory, as some medical schools still do require, or if an in-person quiz is on the schedule. Before attendance began to drop, medical educators made the classroom an interactive session and the iClicker was used to respond to questions. However, with Power Point presentations now online before the lecture is given, and voice over with the Power Point, why go to the lecture hall? Pull up the Power Point whenever you want, play it at 1.5 to 1.8 speed, and listen to it twice. The thought is that the classroom is wasted time, and you avoid being called on in class.
There is still in-person training. I teach in the second year, which includes small group sessions called Clinical Reasoning Modules (CRMs). In the CRMs, about eight to 10 students are presented with clinical cases by a moderator who leads the discussion on history, physical, labs, imaging, etc. The model used is a version of clinical reasoning called a “mind map,” and it stresses differentials and necessary testing and imaging. Grading is based on participation. As the “clinical expert,” I rotate to all the small groups and answer questions. This is where I get to meet students I have never seen before.
So, if there are no textbooks or lectures, what do the students do to prepare or to learn? Good question! Instead of scheduled lecture time, regular time is scheduled during their day to “study.” Faculty prepares Directed Student Activities (DSAs). The DSAs include society guidelines, videos, online sites like Up To Date and more. Here textbooks are listed, usually as reference rather than test material. As you can imagine, the students are very resourceful and tell me about sites they find on their own that support their learning process. The list I have been informed about and use to refine my DSAs are Baby Robbins, Pathoma, First Aide, Sketchy Medicine, Get Body Smart, Picnomics, and Hardin MD. As you can imagine, the time spent by faculty to screen all these sites is overwhelming. Since our curriculum is problem-based, symptoms or problems are the topics of our DSAs. Since I am a gastroenterologist, my topics are abnormal liver chemistries (not called LFTs anymore), nausea and vomiting, dysphagia, GI bleeding, constipation, diarrhea, and so forth. Can you imagine the time needed to condense these topics into DSAs that are current and learnable using this format?
I have been around a long time and seen a lot of changes, including monumental ones in medical education, from the classroom to clinical bedside clerkships.
To worsen the situation, clinical clerkships have been adversely affected by the pandemic. Many institutions banned medical students from direct patient contact, and in some instances, from entry into hospitals or surgery centers. Virtual patients were used to teach clinical skills devoid of in-person contact or interviewing. When will they get to see patients in person and learn bedside and in-office clinical skills? Who knows with the recent COVID-19 surge. Some have learned telehealth clinical care, which in some cases may be here to stay. Recent legal issues about student participation in clinical care have also started to cloud the problem. How will all this impact future clinical skills?
So, all these issues in medical education will indeed have an impact on health care. Medical educators have their work cut out for them in the new learning environment compounded by a seemingly never-ending pandemic. Not only are medical students educated to pass boards and clinical competencies, but to become lifelong learners. They must learn without DSAs and with doubling of medical technology every several months. When do they learn cost restraints, physical exam, and other competencies?
I know that this essay is called the Last Word, but this is hardly the last word on this topic. Hold on to your hats—this is a new world. Who knows what the new normal will be? As for me, the Last Word is that knowledge can be communicated, but not wisdom.