I had a great time on Monday presenting the "Less is More" concept with Dr James McCormack to the 2nd year UBC medical students. I remember being in second year, struggling to memorize physiological pathways, neuroanatomy, an approach to diagnosing gastrointestinal bleeds, and at the same time being so eager to apply the knowledge in the clinical encounters we had. I can imagine it would be hard to hear "a lot of the stuff you are learning is important, but..."
We encouraged the students to take a step back, to remember they are caring for people (not diseases), and to use their critical thinking and common sense to partner with patients in decision-making. We emphasized the lack of evidence for much of what we do, the need to consider the harms of what may at first seem like benign tests and treatments, and to employ help (like Shared Decision Making tools) when talking with patients.
I've got some ideas as to what to include/exclude/change for similar talks I have lined up in the near future, including wishing I could bottle James' sense of humour and share that with everyone!
The questions from the students were keen, things like (paraphrased):
- How can you approach these kind of ideas when a preceptor doesn't agree? (eg. one might feel pressured into giving an antibiotic for what seems to be a viral infection, because a supervisor insists)
- What is the role of the provincial government, or what can they be asked to change?
- Isn't overdiagnosis and overtreatment a function of physician payment schemes? Do we need to change the way we are remunerated?
Yikes! Next generation of healthcare, watch out! No one has perfect responses to these, but is exciting to exist in a time in which we are working on trying to answer these and other hard questions about the future of our health care system.
You can see a copy of our slides over in the Media/Talks section.