Physician Education Never Ends

I recently read, with great interest, Dr. Atul Gawande’s latest article in The New Yorker entitled “Personal Best”.  In this thought-provoking piece, Dr. Gawande writes about the importance of coaching in many fields of endeavor, including athletics, music, and even opera-singing.  He goes on to make the argument that such peer-to-peer instruction is often lacking in the field of medicine.  I would take issue with this statement.   In my young career I have been struck by the almost daily opportunities I encounter for continued learning. Most notably, a new program within Kaiser Permanente, entitled Physicians Helping Physicians, has the sole aim of helping young as well as veteran physicians to improve their efficiency and interactions with patients.

I completed my fellowship in Cardiology at St. Vincent’s Medical Center in New York City three and a half years ago and immediately moved to California to join the Department of Cardiology at Kaiser Permanente in South San Francisco. I must admit that I initially found it quite daunting to assume the responsibilities of an attending physician.  I no longer had a senior cardiologist looking over my shoulder, ready to guide me in the management of a patient. The buck now stopped with me. Fortunately, I was not as alone as I first thought. I was lucky enough to have several colleagues within my department that I could turn to for advice.  I often found myself walking to their offices to seek help with a difficult clinical scenario or an ethical conundrum.   Kaiser Permanente also arranges for a “New Physician’s Orientation” each year that allows new physicians to share their experiences with each other and receive guidance from assigned mentors.

I am now three and a half years into my career and have had the benefit of discovering several other opportunities for professional growth. In the Cardiology Department, we have weekly cardiac catheterization conferences. Non-invasive and interventional cardiologists and cardiothoracic surgeons from across northern California attend these teleconferences, where complex cases are presented and clinical decisions are made after obtaining input from the various specialties. In addition, we have the opportunity to attend monthly journal clubs, weekly medical grand rounds, M&M conferences and Case Management meetings as well.   Surely there are endless opportunities to expand medical knowledge, if one desires to do so.

But perhaps the most beneficial of all programs is Physicians Helping Physicians. In this ground-breaking enterprise, physicians, with proven abilities across all specialties, are given the opportunity to observe their peers during their workday. They scrutinize everything from the medical assistant’s rooming process, the physician’s clinic visit and even the after-visit charting time. This presents the opportunity to critique not only a physician’s clinical acumen, but also their interpersonal and organizational skills as well as computer acumen.  

I had the chance to participate as a mentor in this program, and am impressed by the substantial benefit that even a small suggestion can make in a physician’s daily life. I recall observing a colleague attempting to deal with the innumerable lab results that fill their inbasket on a daily basis. I was able to demonstrate a process, using Kaiser’s computer system, that can email the results to the patient, along with a comment from the physician. Alone, this small intervention may not seem like much.  However, when multiplied by the many results we receive in a given day, this can lead to considerable time saved. The look of amazement and gratitude upon making this discovery of improved efficiency was truly inspiring.  I only wish we could have made this intervention earlier.

Perhaps not all fields of medicine, or all areas of the country for that matter, have access to such a wide variety of education experiences. Certainly, we in the Bay Area have the fortune of several world-class institutions right here in our backyard, along with advanced technology that gives us access to conferences held at other facilities.  Perhaps some physicians are more isolated than I am and do not have the benefit of nearby peers that they can count on for advice or guidance. I hope that we can work together to create educational opportunities for all physicians to continue to grow and reach their personal best. Ω

Dr. Zuckermann is an internist and cardiologist and practices at Kaiser Permanente in South San Francisco.