Stanley Shi-Dan Liu, MD
Requests for Single Reprints: Stanley Shi-Dan Liu, MD, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224; e-mail, firstname.lastname@example.org.
Liu S.; An Oasis in Time. Ann Intern Med. 2010;153:614-615. doi: 10.7326/0003-4819-153-9-201011020-00014
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Published: Ann Intern Med. 2010;153(9):614-615.
When I first started my intern year, my senior residents repeatedly told me that the Aliki rotation would be one of the best patient care experiences that I would ever have. The Aliki Initiative at the Johns Hopkins Bayview Medical Center is a unique inpatient wards rotation in which internal medicine residents manage one half of the usual patient census and play an increased role in patient care after discharge. Named after the philanthropist who funded it, the Aliki service is designed to help residents to better know their patients as individuals and to learn about issues related to transitions in care. The program is currently studying how this service compares with a standard inpatient ward team in improving educational and patient care outcomes. As for the residents who take part in it, the Aliki rotation remains a favorite. One senior resident even said that the Aliki rotation made her love medicine again and reminded her of why she once dreamed of becoming a physician.
VNCAJ, CCHP, CCC
November 8, 2010
Regarding A Medical Oasis
As an internist who trained in the mid 1980's, I had the privilege of enjoying the kind of significant patient care described by Dr. Liu in his essay regarding a medical service "designed to help residents to better know their patients as individuals." At the time, this type of experience was not due to limiting patient numbers, but by the dual "extenders" of long resident work hours and long patient length of stay. Both of these parameters have decreased, leaving physicians-in-training with less time with their patients. Medical educators desperately require answers to the questions raised by Dr. Liu's essay. It is curious that, in a profession where evidence and outcomes are our hallmarks, there is so little concrete information about which types of experiences during training result in the most competent and humane physicians.
Michael E. Miller
November 18, 2010
Communication is important
Two major themes emerge from Dr. Liu's essay: "An Oasis In Time", Annals, November 2,2010. The first, as the title states is indeed time, specifically the clear benefits accrued to physicians and presumably our patients if we had more of it to spend with them, and second, a little more nebulously discussed, is communication, particularly the significant downside of inadequate or worse, poor communication between physicians and other care providers.
I'm more interested in communication, not only because of the consequences to patients but also its effect on physician workload and frustration managing it. I am observing the troubling paradox of diminishing quality of physician communication as the technology of communication has dramatically improved. Current technology has seduced us into believing that just "sending an "e"", or a stack of redundant, electronic or printed notes with a few well hidden quanta of useful information suffices for adequate communication.
The accurate exchange of information is not only critical for excellent patient care, it also reflects in essence, the professional courtesy physicians and other care givers extend to each other to best manage the patient. I believe it is unprofessional to shirk this responsibility. A little "Golden Rule" directed behavior-don't do to other physicians that which you would not like done to yourself-is in order.
To that end I suggest we reevaluate the use of the telephone. A real- time, embodied voice, when possible, is a much better communicator to discuss important information, and it's much more efficient. A few minutes on the phone with the listen and speak of conversation with another physician is effective, often pleasant and usefully informative, empathic, and capable of providing important subjective information and discussion points. I still speak faster than I keyboard, and I don't find email trails enjoyable to navigate. I much prefer being interrupted for an important phone call than belatedly fmding a time sensitive 15 page fax or a half dozen emails that consumes considerably more time-it ultimately makes my day easier and helps me deliver better care.
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