Embracing Change in Medical Practice

In October we attended the American Academy of Pediatrics (AAP) National Conference and Exhibition in Washington, D.C. Taking time away from our micro-practice is always difficult as it means arranging for coverage from local colleagues as well as a loss of income. Still, conferences like the AAP's are important for completing continuing medical education and for interacting with peers from across the country.

Many of the speakers at the conference were informative, however, the two who inspired us the most each dealt with big controversies in medicine. Our blog this month is to thank these two physicians and to encourage others like them to keep questioning the "norms" of medicine.

First, Dr. Sanjeev Arora gave an inspiring presentation about Project ECHO, a telemedicine project, based at the University of New Mexico in Albuquerque (Leann's alma mater for her MBA). We know that many of our colleagues hear "telehealth" and immediately feel threatened that physicians, from Bangalore to Detroit and everywhere in between, are coming to treat their patients from afar (and at half the price). Not unlike the perceived threat from retail-based clinics, we feel that we have little to fear from telehealth and, more importantly, our patients and our community have so much to gain. Project ECHO brings the subspecialist knowledge of Dr. Arora and his hepatitis C team to patients out to the surrounding community, sometimes hours away by car, to allow rural primary-care doctors to provide care equal to the care that can be provided at the tertiary care university hospital. Although ECHO started as an outreach for hepatitis C, its mission has expanded to include a variety of chronic, complicated medical problems. As of today, the U.S. Department of Defense and Department of Veterans Affairs have both invested money in incorporating the ECHO model into their departments.

Next, Dr. Richard Pan, a pediatrician and State Senator in California, spoke about the leadership role he took to get California to pass SB277, the law that removed all nonmedical vaccine exemptions for school attendance in California. How we wish we had a similar law in Massachusetts! Shockingly, we have legislators in our state, the home of scientific pioneers MIT and Harvard University, who readily believe the bad science behind the anti-vaccine movement. At our practice we follow the AAP's recommendation to treat non-vaccinators in the hope of someday, eventually, winning them over to vaccination. In truth, though, we wish the patients didn't have this ridiculous, scientifically illiterate option. Someone has to be the "bad guy" when it comes to putting public health needs ahead of personal preferences. Sounds like a role of the government to us.

Next time you're wandering through the uninspiring exhibitor floor of your next convention, be sure to take breaks from entering raffles for iPads, and seek out the speakers covering the controversial issues of the day. You won't be disappointed.