Explore this issue:February 2014
MIAMI BEACH—The Triological Society Combined Sections Meeting took the stage in Miami Beach on Jan. 10 for three days of talks, discussion panels, and research presentations geared toward helping attendees improve patient care, tackle new lines of inquiry, and get otolaryngologists thinking about issues big and small.
Tyler Weaver, a fourth-year medical student at Oregon Health and Science University who was scheduled to give an oral presentation, said this was his first exposure to such a conference and that it was a great chance to see how it all works. “When a bunch of minds put their resources together, you can see the advances of the field—it’s a really great opportunity,” he said.
Jeffrey Kerner, MD, an otolaryngologist at New Haven, Conn.-based Cornell Scott-Hill Health Center, said it might be easy to fall out of touch with the field if you don’t make the effort, but coming to the meeting is a great way to keep up with what is happening. “This is one of the more erudite groups of otolaryngologists,” he said.
Jonas Johnson, MD, spoke about the responsibilities physicians face as teachers in his presidential address to the Triological Society. Specifically, he called on attendees to:
Recognize the Stakes Involved in How Well You Teach
“The responsibility that each one of you has every day is amazing,” Dr. Johnson said. “So now we’re going to teach someone how to do surgery. How can you do that? How can you let a junior person help you cut another human being?” The only way otolaryngologists can accomplish this, he said, is to be convinced that the trainee is doing it as well as the teacher could. “Anything else is completely unethical,” he added.
Leave Behind Quality Doctors
Education, mentoring, and sponsorship are of central importance to the specialty, said Dr. Johnson. “If I don’t train some young people, there won’t be anybody when I’m gone,” he said. “We all understand that.”
Remember That Teaching in Medicine Can Be Especially Difficult
Dr. Johnson pointed to medical training as an environment in which trainees want to be independent. “Our trainees don’t want to call me at 2:00 in the morning and wake me up. Our residents want to be offered more responsibility. They want to do it themselves.”
Additional difficulty in training medical staff can come from the nature of performing surgery on a patient. “I would never a let a resident do something in the operating room unsupervised until I have seen him do it, and do it well,” he said. “You have to watch them and trust them before you dare leave the room. This is my ethical responsibility to that patient.”
Supervise the Clinic and the OR
It’s important to watch a trainee examine a patient, make a diagnosis, and prescribe therapy. “Failure to supervise under that circumstance is my problem,” he said. Things are not perfect all the time in the operating room, he added. “What our commitment is to our trainees and then, of course, our patients, is [that] you have to forgive yourself if things didn’t go well. But you must, must, remember why. And don’t ever let it happen again.”
Keynote Speaker Pinpoints Physician Role in the Cost of Care
Physicians have great influence on healthcare spending, and a responsibility to help control it, said Susan Goold, MD, MHSA, MA, professor of internal medicine and health management and policy at the University of Michigan School of Public Health in Ann Arbor, who took the stage as keynote speaker at the Triological Society Combined Sections Meeting.
Dr. Goold, whose research specializes in the ethics of healthcare and healthcare spending priorities, described the problems with the state of healthcare in the U.S. in terms of market failures. For one thing, services are often provided without payment. Then, there’s the “myth of consumer sovereignty”—that although people are expected to inform themselves and wisely choose items in the marketplace, when it comes to health insurance, they often can’t imagine the things they’ll need and, therefore, frequently make unwise decisions on insurance.
She highlighted additional failures within the healthcare system: the free riders who get free services and benefit from those who actually pay into the system and the fact that those with an inability to pay tend to have poorer health than the rest of the population.
—Charles Elmaraghy, MD, Nationwide Children’s Hospital Columbus, Ohio
Physicians have the power to write prescriptions and order tests and, therefore, have a huge role in what is spent on healthcare and on whom, Dr. Goold said. And that comes with a responsibility. “Physicians can and should consider limited resources when we are advising our patients and making decisions,” she said. “It’s incumbent on us as professionals to make these decisions in a way that recognizes they’re using shared, pooled, and limited resources.”
When many options have a similar likelihood of benefit, she said that simply choosing the less expensive option does little toward making a difference.
Dr. Goold urged physicians to work at building trust with patients and their families. “The even lower-hanging fruit is how we respond to patients’ and family requests for what we consider, in our clinical judgment, unnecessary,” she said. “This happens frequently. We need to learn how to handle it as professionals—as professionals committed to seeking and deserving our patients’ trust.”