What is your mission field?

Robert Chang writes…

Ground level work
Taking a break from my prior themes, I just returned from Honduras where I act as clinic director, triage, medical student instructor, pre-operative clinic, coordinator for medical consulting with physicians back home for obscure cases and whatever else needed to be done to keep our one week of general medicine/ENT clinic and surgeries going smoothly.  The week away was refreshing, whether it was the little kids, the cyst-that-was-actually-a-botfly that we removed from someone’s head, or mentoring students (one of whom was featured in the local paper).

It was also good to see old friends on my fourth annual trip, both patients and hospital staff.  Two years ago we diagnosed one little girl with a rare metastatic tumor that was resected and who we eventually funded to come to the NCI for chemotherapy.  She was perky and doing well, smiling widely for those of us fortunate enough to have been a part of caring for her.  We’re growing something bigger each year, in conjoined effort with a friend who goes to the same hospital at a different time.

A computer for everyone??
The foundations of academic medicine consist of education, research and clinical care.  In general, promotion has focused on promulgation of information beyond the walls of the local institution with recognition of expertise by other experts in the field.  In this understanding of academic medicine, we cannot lose the intention of the trifold foundation of academic medicine – its purest incarnation is to raise the level of care that we can provide our patients.

The effects and capacity to disseminate information is often delayed, even in a first world country such as the United States.  We can look to hypertension, coronary artery disease and diabetes management and grimace in recognition of this shortcoming.  To some degree, the issue for us is an overwhelming amount of information with a lack of organization and prioritization.  There are few people in medical school who end wishing that there was more to study.  In less developed countries, it is access to information that is often the rate-limiting step, for political, social, financial or logistical reasons.

I admit that I initially scoffed at the idea of providing all people access to a computer.  I went to Togo, West Africa the next year and shared medical school stories from different parts of Africa.  One hour commutes to attend classes at different lecture halls every day with few shared textbooks.  Limited enrollment based on “who knew who” or money.  My frustration of not having easy access to knowledge that I knew would be helpful and so forth.  Resources, particularly knowledge, exist but are just not easily accessible.  The possibilities with computer access seemed much more real and important all of a sudden.

The development of the second generation copyright and a greater understanding of the difficulties of generalized Internet access represent two additional technological developments that are key for any sort of sustained information exchange that allows credit where credit is due and the infrastructure needed to disseminate information appropriately.

A bigger vision than I’ve had in the past
My time overseas has reinforced the view I’ve developed in my current position that the person in front of me is not the only person that I need to be treating or thinking about.  The above developments, with the very real need for dissemination of medical information and the difficulty of producing academic products that break out of the local scene for promotion, all blend into very intriguing opportunity for hospitalists and academic medicine as a whole.  Imagine an academic hospitalist program with an established relationship with hospitals in various international settings, first through third world.  Physicians move from said hospital to various other institutions and back in a continuous fashion multiple times over years.  The mutual information exchange about disease processes through patient care and physician-physician interaction are inherently beneficial to individual physicians.  The opportunity to lecture and leave information available for future learning and continual revision is beneficial for the recipients as well as the involved physician.  The ability to develop core lectures that are assessed by an international panel of experts redefines the “peer-reviewed” academic product that all participants benefit from.  These bridges would foment increasing relationships between research groups that would otherwise have no opportunity to collaborate.  International rather than national recognition, which is already an informal competition, is very likely to be the official future measuring stick of academic centers.

We’ve just started these discussions in our hospitalist group – is this an arena that physicians have discussed in your groups?  Swine flu and economics have often dominated recent conversations but these things will all come to pass.  Reforming the way we practice our trifold mission on the international scene is to look into the future.

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