"Keeping up" demands more than clinical knowledge

Ethics Forum. Aug. 1, 2005.

How can the family physician stay current with medical advances?

Which disciplines or knowledge bases do you draw on most, as a family physician, and how do you maintain such broad competency?

Reply:

The thought of "keeping up" in medicine has always produced angina in the hearts of specialists and novices. The seasoned generalist, oddly, has grown accustomed to the race. How do we find equanimity when there is so much to learn, so little bandwidth to our brains?

We often find it through teaching. Medical students and residents are amazingly facile at performing clinical exams and reaching working hypotheses. Diagnosis is usually the first concern of the student; treatment preoccupies the resident. What remains to be taught is the art of medicine. Physicians are managers: We manage the patient's clinical course and our own emotional investment in its outcome.

"Keeping up" is a problem encountered along every career ladder.

Our solution relies on the old adage, "It's not what you know but who you know," where "who" always refers to the patient.

Electronic health records have made it possible to grasp -- on command -- a practice profile: demographics, health maintenance, outcome markers. It is the report card by which physicians will be compensated and recertified. The new parlance is "performance." Insurers are looking at diseases and treatment guidelines to gauge our performance. This is progress, both overdue and commendable.