More Medical Schools Are Screening Applicants Closely for People Skills

Bedside manner is a very important element in patien care.  So much so that medical students are being given a basic training in how to have better people skills.  The NY Times had an article, “More Medical Schools Are Screening Applicants Closely for People Skills” which describes new means of teaching and testing how these future doctors will act in practice.  When i was first learning about chaplaincy work, one of the most valuable lessons I learned was something quite simple.  If a person enters a room and completely faces the patient, that patient will perceive the person having been in the room longer than they really were.  As such, body language and posture will often be the first step of refining people skills. 

The article goes further, as it indicates a need to teach the students how to be effecient and quick thinking while also being “in the room” with the person, even for a short interval.  Additionally, part of the article’s description of the increased need to find people friendly doctors is to also teach the need to work in a team.  Healthcare is no longer provided as a medical model in its own right as most people are looking for holistic care, requiring multiple disciplines to be available.  This is something hospice does well but other areas of medicine are not up to speed with yet. 

Doctors save lives, but they can sometimes be insufferable know-it-alls who bully nurses and do not listen to patients. Medical schools have traditionally done little to screen out such flawed applicants or to train them to behave better, but that is changing…

At Virginia Tech Carilion, 26 candidates showed up on a Saturday in March and stood with their backs to the doors of 26 small rooms. When a bell sounded, the applicants spun around and read a sheet of paper taped to the door that described an ethical conundrum. Two minutes later, the bell sounded again and the applicants charged into the small rooms and found an interviewer waiting. A chorus of cheerful greetings rang out, and the doors shut. The candidates had eight minutes to discuss that room’s situation. Then they moved to the next room, the next surprise conundrum and the next interviewer, who scored each applicant with a number and sometimes a brief note.

The school asked that the actual questions be kept secret, but some sample questions include whether giving patients unproven alternative remedies is ethical, whether pediatricians should support parents who want to circumcise their baby boys and whether insurance co-pays for medical visits are appropriate.

Virginia Tech Carilion administrators said they created questions that assessed how well candidates think on their feet and how willing they are to work in teams. The most important part of the interviews are often not candidates’ initial responses — there are no right or wrong answers — but how well they respond when someone disagrees with them, something that happens when working in teams.

Candidates who jump to improper conclusions, fail to listen or are overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.

“We are trying to weed out the students who look great on paper but haven’t developed the people or communication skills we think are important,” said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carilion…

A pleasant bedside manner and an attentive ear have always been desirable traits in doctors, of course, but two trends have led school administrators to make the hunt for these qualities a priority. The first is a growing catalog of studies that pin the blame for an appalling share of preventable deaths on poor communication among doctors, patients and nurses that often results because some doctors, while technically competent, are socially inept.

The second and related trend is that medicine is evolving from an individual to a team sport. Solo medical practices are disappearing. In their place, large health systems — encouraged by new government policies — are creating teams to provide care coordinated across disciplines. The strength of such teams often has more to do with communication than the technical competence of any one member.

“When I entered medical school, it was all about being an individual expert,” said Dr. Darrell G. Kirch, the president and chief executive of the Association of American Medical Colleges. “Now it’s all about applying that expertise to team-based patient care.”

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There’s No ‘Average’ Cancer Patient

In the following opinion piece, the question is posed about keeping a drug on the market because it helps some people but not others.  He is arguing that no matter how much we might be able to predict prognosis of cancer patients, we have to be reminded how each case is different.  Since a prognosis is an average, there are some who outpace the average significantly.  Unfortunately, with the increased concern for fiscal responsibility over patient choice, health care is losing the argument about individualized care. 

Last year, the FDA began the process of revoking Avastin’s approval for breast cancer. Some leading oncologists applauded the decision, arguing that, for the average patient, Avastin doesn’t work very well and has significant side effects.

Patient advocates and thousands of women who credit their survival to Avastin argue that it’s unfair for the FDA to remove one of the few available options for patients diagnosed with terminal cancer. They’re right.

Avastin originally hit the market in 2004 to treat other cancers, and in 2008 the FDA conditionally approved it for breast cancer. Initial testing showed that, on average, Avastin didn’t lengthen patients’ overall survival time. But it did slow tumor growth, giving many patients a longer “progression-free” survival. What this means is that dying patients get a precious few extra months of quality time they can spend with family and friends, travel rather than being confined to a bed, or get their personal effects in order.

A small percentage of patients taking Avastin have been cured of their breast cancer. But the drug’s permanent approval hinged on the results of two additional clinical studies focusing on the progression-free survival end-point experienced by the majority of Avastin users. As before, neither study found an increase in overall survival, but they did record modest gains in progression-free survival—about five and a half months longer than those on the alternative treatment. That wasn’t enough for the FDA, so the agency moved to revoke Avastin’s approval for breast cancer last July…

When well-known scientist Stephen Jay Gould was diagnosed with a rare form of lung cancer in July 1982, he was told the diagnosis meant a median survival time of just eight months. His doctor gave up on him. But he lived another 20 years.

“Means and medians are the abstractions,” he wrote in Discover magazine in 1985. “Therefore, I looked at the mesothelioma statistics quite differently—and not only because I am an optimist . . . but primarily because I know that variation itself is the reality.”

Like Gould’s doctor, the FDA and its technocratic supporters are giving up on breast cancer patients because of their slavish obsession with median response rates. Everyone can agree that, on average, Avastin does not extend most patients’ life expectancy. But some patients have responded incredibly well, living years longer than expected. The medical community calls them “super responders.” Statisticians might describe them as “outliers.” But they’re real people, alive because of Avastin.