Pedagogical Osmosis Between Nurses and Physicians

There is going to have to be more pedagogical osmosis between nurses and physicians.

What is “pedagogical osmosis”?

Just a fancy phrase for redesigning medical and nursing education.

Nurses need to have more education about the sciences and ways of thinking undermining medical knowledge and practice.

Physicians need to have a more profound understanding of healthcare communications, people-skills and a patient-centric appreciation for how needles, tests and bad news feel.

The Crimean War ended a longtime ago.

Sadly, the military-industrial frame-of-mind it engendered in healthcare persists in today’s academic and practicing institutions.

It’s not easy to unthink entrenched patterns that cause the wrong behaviors.

But it needs to be done.

Phil Baumann

Online Health Content: The Challenge of Interpretation

Is there quality health content online? I think that there is – you just need to know where to find it.

But the real challenge with health content online isn’t so much the content (although that’s a huge concern). The big challenge is Interpretation.

Health data without context isn’t information. Data is just data – it has no value in itself.

Information, however, is the relevant data needed to make a decision based on risk.

And this is where rests one of the hardest tasks of using the Web as best as possible in health.

In The Problem with Casual Medical Advice, Bryan Vartabedian (@Doctor_V on Twitter) raises a related point about the problem of limited context:

Everybody understands legalese.  Few, however, understand the complexity of a properly executed medical encounter.

This matter of interpretation in order to convert data into information is perhaps one of the ‘holy grails” of online medicine. I don’t know if we’ll achieve it anytime soon – not at least until our media and remote-monitoring technologies go Star Trek.

But there probably are some ways to problem-solve which medical schools and researchers may want to start exploring.

For now, though, getting more providers comfortable with being online is an important first step – that way they’ll learn how to port their patients into the right contexts of communication and collaboration.

As the public expects more physicians and other practitioners to engage them online – or at least have some presence – this problem of ensuring the proper contexts of interpretation will continue to need attention.

Perhaps this is something which Ted Eytan (@TedEytan on Twitter) and his colleagues can continue to do through the kind of work they did on The Permanente Journal. Do check out what they did – their work has been long in the waiting.



This Gets My Attention

By way of a tweet from @JaeSelle, I found this post from Sarah Cowherd (@SarahBethRN), where Beth relates the story of using an iPhone application during one of her shifts. She’s writes that she is then approached by her supervisor who tells her:

Sarah, you need to put your phone away while working. It really looks bad, and not to mention you are not focused on patient care.

Sarah was using Medical Lab Tests, an iPhone application, in the care of her patient.

Now this is very interesting.

Sarah’s view of patient care as a “new young nurse” is that technologies like iPhone tools can be used in the ordinary course of care provided to patients. Sarah has a perfectly caring view of technology – that mindful use of technology can enhance the recruitment of knowledge and the delivery of care.

Sarah’s supervisor’s view of patient care is that the caregiver’s eyes and other natural faculties of attention are what define care, and that technological devices are likely distractions – and thereby weaken patient care.

Niether of these nurses are wrong. They each beam their perspective based on their own backgrounds. The technological and cultural conditions in which Sarah grew up were different from her supervisor’s.

And yet we know the “right” answer. We know that technologies won’t go away. We know that technologies – ventilators, stethoscopes, palpation techniques, medications – are vital to health care.

Sarah’s supervisor is right, in a sense, to claim that a nurse or a doctor using an iPhone “really looks bad”. Patients do want to know that their caregivers care and pay attention to them. My sense is that Sarah’s supervisor cares deeply about patient care, but that she just hasn’t had the nudging needed to know that an iPhone isn’t a toy to everybody.

She hasn’t been shown – vividly – how re-purposeful these technologies can be.

What…we’ve…got…here…is: Failure to communicate!

Or rather: connect.

We have a disturbing disconnection between the past and the future (which is now). It’s disturbing on these levels:

  • Technological literacy and competence is core to nursing and medicine. Core.
  • Willfully disregarding the cultural ramifications of technological disruption within Healthcare is tantamount to inattention to patient care
  • 21st Century nursing and medical educators have a duty to instill and encourage the proper use of technologies clinically
  • Hospitals have an obligation to create environments that foster innovation, problem-solving and patient communication and education for this century

Sarah’s story may seem like a small one on the surface.

But this problem goes deep. Deep. Deep Deep DEEP.

This partially explains why we still have paper medical records and can’t have ubiquitous, invokable and secure medical data in the year of our dear lord Two…..Thousand…….and……..Ten.

This mentality has cost all of us dearly.

Now Josh raises a good point about form: the iPad may alleviate clinical concerns about how providers look to patients as they access information through a plate of glass. That the iPad’s size and design creates a mutual ambiance between patient and provider. (Something to think about in healthcare technology innovation.)

Nevertheless, we need a way to solve this problem. This failure to connect the “old” world with the “new”. (They’re really the same worlds – just different experiences and lenses.)

We need education here.

We need more nursing and medical students to express their views without fear of retribution from those ignorant of their world.

We need more hospitals and schools to get more involved with today’s technology – and not just setting up a Twitter account and a Facebook Page. I mean, really ripping it up and taking the time to understand – at a fundamental level – just what’s happening in the world today.

I often hear “Oh, well, Healthcare always has a lag”.

Screw the lag. That’s no excuse.

Baby steps aren’t going to do it. Not anymore. Not today.

This gets my attention.

I hope it gets yours.

I hope it gets the attention of those nurses who’ve been abused and disrespected and shit upon for thirty years while undyingly giving dignity to the dying, who – after feeling abandoned – walled themselves off from the world around them.

I hope it gets Sarah’s. I hope you wish her the best in her career. I hope you Like her.

Because Sarah represents the bright future of caring nurses who just want to bring Healthcare into the 21st Century.

Is that too much to ask for?