"Good Medicine"
32 years ago, on March 1, 1980, I received a letter from my uncle, Dr. Robert Tranquada. I had written to him to ask for advice as I contemplated pursuing a career in medicine. I had planned to use my Stanford education to be a high school drama teacher, but I was questioning my suitability for the "noble profession." Bob's response included the following wisdom, "...The physician is almost inevitably endowed by others with a degree of wisdom and respect which he may or may not deserve, and it is because of this that a terrible responsibility for integrity and wisdom is placed upon him...We have to make tough decisions on a daily basis in which we must sort out our own desires and prejudices from the interests of our patients. It is the ability to respond to those daily challenges without adopting destructive techniques which keep us from remaining empathic and humane, which sort out the really good physician from the hack..." The words of my uncle have inspired my perspective on what it means to be "patient centered" in our work as researchers, teachers, and clinicians.
Speaking at Family Medicine Grand Rounds on Monday, Dr. Peter Crookes from the Department of Surgery shared stories of the history of medicine that reminded us of both the most noble and the most tragic elements of our profession. He quoted Louis Pasteur, "...chance favors the prepared mind." In reflecting on Dr. Crooke's regard for the role of story telling in informing our approach to patient care I performed a sophisticated literature search (I "Googled" the quote) and discovered more context for those words of wisdom, "Where observation is concerned, chance favors only the prepared mind...There does not exist a category of science to which one can give the name 'applied science'. There are sciences and the applications of science, bound together as the fruit of the tree which bears it."
This is how I choose to approach my participation in the CTSI collaboration. I believe that this is our mission at the KSOM, and it will require the collaborative and systematic breaking down of existing silos which are preventing us from creating the fruits of collaborative learning, teaching, and patient care. Already, my research has been informed by collaborative discussions with the following scholars and clinicians, facilitated by CTSI staff and programs, and the projects we are now involved in together:
Dr. Kathleen Ell and Kim Goodman, LCSW, USC School of Social Work- we are collaborating with Tania Benacerra, LCSW, Hope Street Center of California Hospital Medical Center, Family Preservation Project to integrate social work students into PCMH Care Teams through collaborative teaching, training, and patient care.
Dr. Sarita Mohanty, Departments of Internal Medicine and Emergency Medicine, Medical Director COPE Health Solutions- Specialty care access within the safety net (a collaboration with LAC-USC and Harbor-UCLA), Patient Centered-Accountable Care Organization development (local and regional). Recently, Drs. David Goldstein, Michael Carp from Internal Medicine, Dr. Glenn Ehresmann (Rheumatology), Dr. Tony Senagore (Colorectal Surgery), and Don Larson (Neurosurgery) have agreed to share their knowledge to inform our work.
Dr. Astrid Heger, Department of Pediatrics, Executive Director of the Violence Intervention Program- development of a KSOM Patient Centered Medical Home Teaching and Research Center, where KSOM students, learners from other professional schools who will serve within the "Care Teams" that will care for Americans in the next decade, and faculty from KSOM and other USC professional schools, including specialists and primary care physicians can test, learn, research, and teach the fundamentals of patient care in a state of the art PCMH. This project enjoys the enthusiastic support of our medical students, Faculty, and Administration leadership.
Dr. Matthew Meyer, VP, Best Practices and Dr. Curley Bond, Medical Director respectively, Didi Hirsch Mental Health Services- developing, testing, and spreading new models for integrated medical and behavioral health care services based within the PCMH.
Dr. Robert Vinetz, Director, Pediatric Asthma Disease Management Program, QueensCare Family Clinics- using the Improvement Model from the Institute of Healthcare Improvement to drive our redesign work in transforming PCMH's within this community, redesigning Well Child Care, and training physician leaders to effectively lead the Care Teams of this decade.
Dr. Andrea Hollingshead (Annenberg School of Communications) and Dr. Peter Carnevale (Marshall School of Business)- the application of innovations in Crowd Sourcing techniques to inform research on PCMH and ACO development.
I'm looking forward to this unprecedented opportunity for academic and clinical collaboration made possible by participation in the CTSI. I hope that the stories I share with you in this virtual space will inform and inspire our work together as we honor the mission of the KSOM and our professional obligation to care for not just the patients in front of us, but for our "community" as well, however we choose to define it.
Brian Prestwich, MD
Assistant Professor of Family Medicine,
Medical Director, USC Family Medicine Center at California Hospital
Some Thoughts from our OCE Partners
