Monthly Archives: May 2011

Human Factors in Patient Safety

Just A Routine Operation from thinkpublic on Vimeo.

A recent comment asked about sleep deprivation and patient safety. Should we trust doctors who have been up more than 24 hours in a row, when we know their decision making might be impaired? The debate on medical student/resident work hours is enough for a whole other post, but today I’m going to talk about patient safety.

The video “Just A Routine Operation” highlights the dangerous realities of patient care. Mistakes happen. The hospital which is traditionally perceived as a place for people to get better is also one of the most dangerous places for a sick person to be. Doctors over-investigate, super-bugs lurk the wards and decisions are made that impact patient lives.

Having recently done some trauma simulation with other medical students – one where we had a team leader, defined roles, a emergency scenario – I believe there is still a long way to go in making our health care safer. We live in an age of technology, one where imaging and cutting edge interventions are everyday occurrences. There is so much focus on the best evidence based medicine, guidelines and protocols to have best outcomes. Yet, we also live at a time when health care is becoming more fragmented than ever, from generalists and specialists to shift changes and  patient handovers. Long gone are the days where one doctor would look after a patient from start to finish. In this interdisciplinary age, every health care profession has a role to play.

To be honest, they don’t teach us a lot about effective communication in our medical training, at least not in the classrooms. We are given some simulations here, some day classes on closed loop communications, and maybe a handout on clear written communication. We might be exposed to some statistics on medical errors, sessions on isolation precautions, maybe even a talk on things like SBAR.

But as a whole, the health care industry has not taken the same steps on quality assurance, human factors and safety as industries such as aviation, engineering, transportation and food.

Seeing this video today reminded me that I’ll have to be vigilant about how I communicate with my colleagues. That learning to work as a team is often more important than book smarts. I hope you can pass this video on to a health care worker, whether it’s a doctor or a nurse or someone involved with patient care, so that they too can make their workplace a safer place for patients.

ER Shifts

Haven’t been able to get into a posting routine this week. ER shifts requires you to work all sorts of odd hours and you’re pretty exhausted by the pace of it after you’re done. You try to sleep at strange hours but never feel truly rested, because you know the next shift is just around the corner.

Just dropping a line. Will update in the next 48 hours with a post.

5 Reasons Why Studying for the MCAT on your own is Better than taking a Course

http://www.flickr.com/photos/gergtreble/4284959500

Ever feel like Kaplan’s and Princeton Review’s MCAT courses are a rip-offs? Did you ever found your MCAT teachers/tutors/classroom experience not helpful at all or a waste of time? Every summer, thousands of keen pre-med students will sign up for these MCAT courses in hopes that it will help them do well on their MCAT. The worst part is that these people who sign up for courses often do no better than their peers.

Whether you’re taking the MCAT again or planning to write the MCAT for the first time, I hope I can convince you that studying the MCAT on your own, without the help of a review course or tutors, is a viable and excellent option. If you want to learn HOW to SELF STUDY for the MCAT, check out my post on the steps needed to do it here. (How to Self Study for the MCAT)

I personally believe that studying for the MCAT on your own will save you money, will be flexible to your schedule, will be tailored to your strengths and weaknesses and will get you results that you want.

1. Costs (It’s a lot cheaper!)

Let’s be realistic and forget all the premed delusions for a second, the MCAT is an expensive test to take. Registration costs $235 + additional fees. Some people say it’s a small price to pay for the chance to be a doctor, but I know of hundreds of things I could do with that money that would be much more fun and way less painful. Taking a look at Kaplan’s courses and The Princeton Review’s courses, prices range from $1500-1800 at Kaplan, $2000 at TPR and $7800 (wtf?) for Kaplan’s MCAT Summer Intensive.  Even Examkracker‘s course runs for $200!

That is a lot of f***ing money.

They might give you a lot of textbooks and electronic resources. They might have simulated exam situations and a teacher you can ask to answer your questions. But you don’t need that to do well on the MCAT. Q: How much money did I spend studying for the MCAT on my own? Other than the registration fee, A: ZERO DOLLARS ($0). Less than $50 bucks totals if you want to include notebooks, highlighters, transportation to the library. And I got by just fine, wrote it once in August 2007, got a 36Q and was accepted into medical school.

Now everybody doesn’t have to be as frugal as me. I used a lot of borrowing resources (old tests, prep company books) from friend’s who had taken the MCAT, checking out books from the library and free internet resources. Yes, you can spend money to study for the MCAT, go buy some workbooks or even an online course which though will run you several hundred dollars, will be a lot cheaper.

The point is: You will save lots of money studying for the MCAT by yourself. Use that saved money and take a vacation after you write that grueling test that ruined your whole summer. Lots of my medical student friends did it on their own, and look where they ended up! Not in purgatory hell as these test prep companies would want you to believe.

2. Convenient and Flexible Schedule

Did you ever want to skip your MCAT classes because your friends were holding a nice summer BBQ with lots of friends and good food, but couldn’t because you had this guilt that you paid so much money already that you might as well go to class? I never did.

The flexibility and convenience of studying for the MCAT by myself was that is it was on my schedule! This was my favorite aspect of it. I never had to commute to a center to be taught or go to a classroom to simulate a test situation. I could do it at home, or at the library, or wherever I liked, whenever I liked.

Granted, the schedule I devised for myself wasn’t a breeze. I gave up many weeknights and weekends studying, but I got to choose which ones I could take off also. Because I studied for the MCAT by myself, I was able to work that summer and even fit in several weeks of traveling.

I created a schedule at the beginning of the summer, but I was able to modify my schedule along the way. I would move days around, change topics to study and have breaks or extra study sessions as needed. If there were important events going on, I would make sure that my MCAT studying would fit around my life, not the other way around. In the end, I still covered everything that needed to by studied without having to sacrifice as much as if I did take a class.

3. Individualized and tailored curriculum

Just like wearing a fine suit (or dress?), having a MCAT study plan specific to your strengths and weaknesses made studying that much better. I didn’t have to alternate to some schedule set out by a company that only knew my credit card. I could tailor my studies to the areas I needed most.

For example, I had just finished my physics and chemistry courses in school, so I knew that I was a lot stronger in those sections. As a result, I focused most of my early studies in my weaker areas of biologic sciences and verbal reasoning. In fact, I spent over 80% of my time in those two sections because I knew from my diagnostic test that those were my lowest marks.

I did what worked for me. I studied the hard stuff or did practice exams in the evening when I was most alert. I checked my answers in the afternoons when my mind was more lazy and passive. You have to do what works for you, and you know yourself better than these test prep companies.

4. Control and Autonomy

I believe that external motivation factors (such as grades, deadlines set by others) are not as powerful as internal motivation factors (self-actualization, setting personal goals and achieving them).

From the start of my MCAT studying, I was in control. I took ownership over my studies. If I did bad, I had no one to blame but myself. If I did well, I wanted to know how I did it and how I could replicate it.

I had to analyze why I would get some questions correct and others wrong on my own. As a result, I figured out early in the game what pitfalls I had to avoid and which type of questions I could breeze through quickly. Once I had identified my problems and solved my common mistakes, my studying technique and scores improved quickly.

Test prep companies offer you an “analytical breakdown” of your scores and what subjects and type of questions you got wrong. But they often offer you generic advice that really doesn’t help you in the end. I know because I’m guilty of telling my students, when I worked for Kaplan, that they had to use the “methods” we taught them. I would say something like “you’re falling into the 3 most common mistakes with reading passages” and then spew some stuff I didn’t quite believe myself. You begin to care less when you have 30 students in your class all on different levels. Especially in verbal reasoning, which still doesn’t make any sense to me, I think you should just come up with your own strategy to tackle the passages and if it works, it works.

5. Results

But the real bottom line is results. I think you can get great results from creating a study plan for the MCAT by yourself. You get to choose resources that you find useful. You get to focus on what you need to do to improve, not a generic package that is given to hundreds of students.

However, if taking a prep course works for you, go for it.

It’s hard to know if one way is better than another. I don’t think there’s any randomized control study out there that would figure this out, I would hate to be in the treatment group. Everyone studies for the MCAT differently, so if you believe one way will give you an advantage by the time test day comes around, do it.

WARNING:

Studying for the MCAT by yourself isn’t for everyone. You need a certain degree of self control, motivation and work ethic to study for the MCAT on your own. The people who do are usually independent learners who can create their own schedules and find the right motivation to study without anyone pushing them. There’s nothing wrong with taking a MCAT course, and if you believe it will help you, go for it. I am in no way looking down on those who do, in fact at  Kaplan the party line (and I did believe it) was that we provided a useful service to those who wanted it.

This post was mainly on WHY you should study for the MCAT by yourself. For HOW to study for the MCAT on your own, please refer to my guide (How to Self Study for the MCAT)

Best of luck to people studying/writing the MCAT. Would love to hear your feedback in the comments below. Let me know about your experiences with prep companies, your own success stories of personal perseverance and ways to study the MCAT on your own! 

Inspirational

Although I don’t do any rock climbing, I found this video quite inspiring. It’s crazy to imagine what the human spirit can accomplish. There’s something about setting lofty goals and achieving it. Hope this video adds some motivation to someone out there!

Physician Hypocrisy

In cardiology we know that there are several risk factors for developing cardiac heart disease: (1) Age (2) Gender (3) Family History (4) Hypertension (5) Smoking (6) Hypertension (7) Diabetes (8) Dyslipidemia. Age, Gender and Family History are non-modifiable risk factors, things we cannot change. The rest we can do something about.

As someone who knows of this risk, we encourage our patients to live healthier lifestyles. We tell them to eat less salt, drink more water, get enough sleep each night. Eat more vegetables, cut back high cholesterol foods and exercise for at least 30 minutes three to four times a week. We often expect a lot out of our patients because we know the potential benefits of these interventions. However, despite all this knowledge, physicians often don’t look after their own health.

It might be from the demanding schedules and responsibilities set before us. Being on call and not sleeping at night becomes a regular occurrence. Skipping lunch to finish seeing patients in a clinic that is running behind. Eating fast junk food because you might not know when you’ll be able to eat next. And who can blame them for lack of exercise when their basic needs of eating, sleeping and going to washroom have not been met.

It might be from the pride and God-complexes some doctors have developed. That they are better than the populace, that their invincible body and mind are not subject to common illnesses. That they are too smarter than the regular commoner because of their knowledge, that they can outsmart the diseases of mankind.

Whatever the reason, I too am guilty for not looking after my own health.

The question I have is, “Does this make me less of an advocate for my patients’ health?” If I can’t set an example on how to live a healthy life, would patients take what I say as seriously?

Public Health Care Inefficiency

Wanted to post this yesterday, but the server was down.

I’m all for voting and all. The results were surprising to me, especially the complete collapse of the Liberals and Bloc Quebecois. But DAAAAAAAAAAMN, lines were long. Elections Canada really has to hire more efficient staff. There were people sitting around doing NOTHING, while only two people were registering over 50+ voters.

It certainly makes me think of the efficiency of private vs public sector. In the private sector, wastes or inefficiencies are removed sooner because they cut into the bottom line. Health care is no different. There are inefficiencies in the hospital system and health administration. A little privatization and competition would definitely reduce unnecessary services, but a lot of people balk at the idea of privatization of health care.

I’m not arguing for the complete privatization like the States. I just think some incentives (whether positive or negative) would be beneficial to the whole health care system. A recent article from the Globe and Mail discusses the way doctors are paid. The comments are quite interesting to read too. Personally I disagree with the problem being how doctors are paid. The problem isn’t Fee For Service (FFS) vs Salary. In fact, FFS can often increase inefficiency and decrease wait times. It doesn’t take a genius to know that billings by physicians will increase if you increase the number of physicians.

The bigger problem is the lack of priority in preventative medicine and family medicine. We need to put incentives on the right type of medical care . Too much money is spent on high-acuity cases that could have been prevented and clogged up hospitals by patients waiting to be placed in homes. Too much money on hot-shot CEO’s who have grand ideas of cutting costs but no experience with real patient care. Persistent families wanting to keep their 90 year old grandpa with multiple strokes and co-morbidities on life support in the ICU with unrealistic expectations.

We can’t go on this way, eventually things will change. Perhaps one day there will be a two-tier system, lots of other countries have done this successfully. Whatever the outcome, I’ll be actively following it.

I never used to think too much about health care costs and delivery. Growing up, I wanted to be a doctor to help sick people and cure diseases. But as you get to know more of  “the system” it becomes more evident how much our health is affected by the systems we create. From ER wait times to delays in surgeries, the organization of our health care is as important to the ultimate care of patients as the treatments we deliver. So I encourage anyone interested in a career of medicine to be informed about these issues. It may seem far removed from your day to day schooling, but one day you’ll be grappling with the system and maybe even changing it.