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Posted by Ishani Ganguli December 10, 2013 07:00 AM
Be it a borderline-worrisome electrocardiogram, a constellation of symptoms that defies a unifying diagnosis, or a laboratory result that is unexpectedly out-of-whack, all questions lead to the Bauer Room - the workspace for internal medicine residents at Massachusetts General Hospital that has come to be synonymous with getting a second opinion. (Other uses include griping about work and getting rid of an oversized batch of baked goods).
This congress of our peers, each of us off to a different branch of internal medicine, offers the power of collective wisdom and specialized knowledge as well as the safety to test out theories in a relatively judgment-free zone: How would you approach this patient? Am I missing anything? Some would say that we learn as much through conferring with our co-residents in the Bauer Room as we do in our daily lunch conferences.
Come graduation this (or another) July, residents across the country will say goodbye to the proverbial Bauer Room and, for the too few of us who are not pursuing subspecialty fellowships, the attendant collegial environment in which to crowdsource patient care. Practicing medicine as a full-fledged (unsupervised) doctor can be both overwhelming and isolating, especially in parts of the country where doctors are scarce. As a result, medicine’s rapidly expanding body of knowledge doesn't always make it into practice.
How do you create a venue for real-time collaboration - a Bauer Room - beyond the walls of an academic medical center? One answer is telemedicine, the decades-old concept that is enjoying growing relevance as we realize that our biggest hurdle to better health care is not ignorance but uneven execution. Arguably one of the brightest examples of this may be a project started ten years ago that is starting to see some neat results.
Dr. Sanjeev Arora developed Project ECHO (Extension for Community Healthcare Outcomes) as a means of sharing specialist knowledge with primary care doctors practicing in rural New Mexico. As he and colleagues recently described in the journal Academic Medicine, the program allows primary care physicians (PCPs) in underserved areas to discuss complex patient cases with other PCPs, as well as with specialist teams, via weekly videoconference. The specialists, trained to treat hepatitis C or addiction, for example, share their knowledge and offer guidance on how to diagnose and treat these patients.
Project ECHO's real-time, collaborative learning opportunities seem a welcome change from more traditional continuing education for doctors. Although there is the potential to sink into groupthink, this is a small risk compared to the enormous benefit of bringing more providers in on evidence-proven practices.
Dr. Arora’s Project ECHO is the sort of brilliantly obvious idea that makes you wonder about its relatively recent adoption. It is also backed by impressive outcomes. After the program began, hepatitis C cure rates in the primary care sites participating in Project ECHO rose to rival those achieved by specialists. Meanwhile, the local doctors reported feeling more empowered and satisfied by their work as a result of the videoconferences and collaboration.
The project has expanded internationally (reaching India and Uruguay) and locally (to the Beth Israel Deaconess Medical Center in Boston). Residents, as well as medical, nursing, and pharmacy students, are now participating. This sort of effort has the potential to recalibrate, or lessen the blow of, the projected national shortage of primary care doctors - not only by making these doctors more effective, but also by making practice less isolating, and therefore more attractive, to trainees and current practitioners.
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