Demystifying Medicine One Month at a Time

I Just Called to Say, “Hey! Check your Sugar!”

Time to say a thing or two about research. At academic medical centers (AMCs–what we used to call ‘teaching hospitals’) like GlassHospital, the holy trinity of mission is comprised of

  1. patient care
  2. teaching
  3. research.

I used to joke that at GlassHospital, our priority list was

  1. research
  2. research
  3. research
  4. —————–
  5. patient care
  6. teaching.

We’re moving away from this toward a more balanced vision. At present, heavy emphasis is placed by the National Institutes of Health (the big kahuna of medical research funding) on translational research.

Translation first meant taking “sciency” science, like cells and test tubes and petri dishes in labs, and trying to make the results clinically relevant (“at the bedside”). Now it’s come to include the concept of translating the research into meaningful impact in the community. The NIH has given a few AMCs (including GlassHospital) tens of millions of dollars to deliver on the promise of taking what we learn in the lab, the hospital, and the clinic, and disseminating it as far and as wide as possible.

This week I spoke with one of our ace medical residents (shameless plug here), who was involved in a very practical research project.

He and his mentors enrolled about two dozen diabetic patients in a trial to see if using cell phones (text messaging) to remind them to check their sugars and take their medicines would make any difference in their ability to manage their condition and have better overall health.

The researchers are studying the results and writing up their conclusions for publication in a medical journal, but what really struck my friend were the transcripts of interviews with the patients after the study had ended.

The patients related in great emotional detail how helpful the text messaging system was to them–it gave them a sense of external motivation to help connect with their inner desire to control their diabetes.

The intervention was cheap, simple and straightforward. I don’t know what the quantitative impact will be on the group of patients with respect to their numbers–the actual blood sugars, and other lab tests that were studied.

But whatever the quantitative impact, the qualitative impact was profound: these difficult to treat patients felt more of a sense of control over their own illnesses. They felt more connected to their health providers, and more empowered to make change that would lead to better health.

Yet now the study is over.

Why, my friend wondered, can’t the medical center appropriate this cheap and simple technology to continue using it for this purpose, perhaps broadening the population that might benefit, or for other uses? It isn’t hard to generate a quick list of ‘low-hanging fruit:’

  • medication prompts
  • appointment reminders
  • programming announcements
  • educational tidbits
  • public awareness bulletins
  • blog posts (hey, a guy can dream, can’t he?)

The scientific process can be laborious. Experiments must be safe, moral, and technically adroit. Results can take years. Communication and diffusion of practice-changing ideas can take even longer.

So the question becomes: how can we shorten the cycle to improve practice when we obtain favorable results?

5 Comments

  1. Joe Marlin

    Sounds like an odd idea for those who are tethered to their phones and are not well organized as to how to manage their health regimens. But a lot of seniors are both forgetful and don’t use the latest phones. Perhaps there are other ways such as automated land line phone calls to remind patients re taking meds, appointments, etc.

  2. pathdoc

    I think AMCs are so obsessed with research, teaching, etc they forget the bottom line. I approached my director about 3 weeks ago with a method change I had been doing, which saved our hospital about $30,000 this year. He told me the emphasis at our institution was more on “creative minds” and that I did not have to worry about such things as cost and trying to “earn my salary.” Apparently this amount of money is not important enough to save.
    I thought “are you nuts??????” For several other reasons I am looking to leave this AMC and go to a private practice arena.

    • glasshospital

      Pathdoc, your story is kind of shocking. In the real world, workers who save money are usually lauded.

      I’m also surprised that given our global economy in the last two years your hospital administration isn’t looking for all kinds of ways to save money. Our AMC had a 10% across the board budget cut and 5% staff reduction–very painful experiences.

  3. $$downthedrain

    I used to joke that at GlassHospital, our priority list was

    research
    research
    research
    —————– This should be “Academic Politics” !!!
    patient care
    teaching.

    • glasshospital

      Right you are.

      I once had a boss who gave me this kernel regarding academic politics: “Nowhere are the politics more vicious for stakes so low.”

      It’s stuck with me.

      -GH

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