Public sentiment about our healthcare system has certainly seen better days. In the spirit of Thanksgiving, let’s take just a few minutes to reflect on what we can be thankful for in the current state of medicine:
- Informed consent: The concept of informed consent has its roots in multiple fields, but in medicine, informed consent was not a formal concept until the middle of the 20th century. Respect for the values of others’ is paramount in patient care, and informed concept is at the heart of ensuring free will in medicine.
- Randomized controlled trials (RCTs): Although clinical trials themselves date back to the 1700’s with a trial of citrus fruits for scurvy, the specifics of RCTs as we know them today developed much more recently. Concepts such as randomization, masking (better known as blinding), and concealed allocation are important elements of controlled trials that all had to be introduced into clinical research in the last few decades. Before RCTs, clinical research was based on case reports of physicians’ experiences in managing certain diseases. RCTs are now the mainstay of establishing best practice and treatments in medicine.
- Intensive Care Units (ICUs): Bjorn Ibsen established the first ICU in Copenhagen in 1953. The first ICU in the US was established at Dartmouth two years later. Technological advances in medicine have often stemmed from ICU care, such as automated monitoring of vital signs and heart rhythms. We can thank such advances for significantly contributing to improving mortality in critically ill patients.
- Electronic charting: Yes, there are problems with electronic medical records. Yes, the “copy-and-paste” phenomenon is unbearable. But as we incorporate more and more digital record keeping, order entry, and prescription writing into our daily lives, the less likely patients are to suffer because of the illegible handwriting that physicians have been famous for.
- Specialty service and ancillary support teams: Teams comprising nurses, social workers, speech therapists, etc., are taking exponentially greater roles in providing excellence in patient care across the spectrum of healthcare settings. Teams such as Wound, Ostomy, and Continence Nurse teams help ensure that patients receive consistent, reliable expert care and teaching when they require it.
- The ACGME competencies: Last but not least, I thought I would mention a recent change in medical education. The competencies have been developed in an attempt to standardize the outcomes in our education and training of medical students and trainees. One long-term goal of the competencies is to ensure that physicians can do more than just take care of diseases; we need to be able to take care of patients in complex health-care systems with a patient-centric approach, and prove to our patients and payers that we do it well.
I am not saying that the current healthcare system is perfect. It has a lot of pieces that need smart people to work together to fix. But let’s at least be thankful for what we have. What else are you thankful for in modern medicine?