Exactly. I think it is a useful exercise. It puts a historical spin on a common approach to teaching medicine (case studies/problem based learning), making it a bit more interesting. Believe me, after you have heard the 100th case presentation about Mr. X, who presents to the ER with X complaint...thinking about how to treat Mr. Lincoln with today's technology would be a welcome respite.
I look at it as not so much "would he have done better," but thinking about how we would actually care for Mr. Lincoln with what we have available now for head trauma - early airway management, prevention of hyperventilation, active cooling, etc.
I have been running Vista since December I can assure you that oddball dialogs like the parent is describing do occur - seemingly without reason. I am running the RTM, not a beta, and I frequently get the same behavior. For example, yesterday I tried to move a file from one directory to another on the same drive, with correct permissions, and I was told I needed to have administrator privileges to perform the operation. Well, fine - but the UAC would not open a dialog to allow me to enter the administrator credentials. Color me puzzled, but it did allow me to copy the folder and then delete it from the original directory with no objection.
This is the kind of useless behavior that will cause the average user to turn off UAC without a second thought.
You know it is funny (in a sad way), but during medical school we were taught that the average physician interrupts the patient within 30 seconds of the start of the conversation and starts asking yes/no questions. Unfortunately we (physicians), tend to miss many of the important bits of information because of that, and the average patient only talks for about 2 minutes if you just sit and listen. Miraculously, I have discovered that if you listen for that extra 1:30, you tend to save yourself a great deal of time ordering tests, drugs, etc. In my experience, patient visits tend to be handled much faster by listening for 2 minutes, asking a few open-ended questions to fill in the blanks, and parting ways with satisfaction rather than misunderstanding and unhappiness.
If I can explain something in 2 minutes rather than spend 5 minutes ordering a drug or test, everyone wins. Of course, this does not always happen, and sometimes the picture is less than clear when I leave a room...but a little extra time spent talking seems to save a lot of time in the end.
Take, for example, the common scenario of the vomiting child. Parents worried, me busy...now I can simply say, "yup, your child is vomiting, we'll give some *insert expensive anti-vomiting medication* and an IV," or I can spend a few minutes explaining the WHO process of giving small amounts (1 tsp or so) of fluid every few minutes so that the child will not vomit, explain how to limit the diet a bit for the next couple of days, and let the parents ask a few questions. In the end, the medication and IV takes an hour+ to accomplish, or the parents spend 1/2 hour giving small amounts of fluid that add up quickly. Either way (usually) the child's mild dehydration gets treated...and with a little more talking up front, I save 1/2 hour down the line.
I am the first to admit physicians get lulled into a "drug for every disease" pattern, but the truth is, a little time, reassurance and education will solve the majority of problems. The trick is knowing which problems that approach won't solve...but that's why I went to med school in the first place (and a topic for another day).
IAAD, and I think you have a very valid point. Most of the drugs advertised on television here in the US are high dollar moneymakers for the pharma companies. In my opinion, this is the biggest problem - the vast majority of the time, much cheaper generic medications which are equivalent (or sometimes superior) in efficacy are available. The ads are just marketing and serve to drive up the already astronomical price of healthcare in the US.
Personally, I usually ignore requests and spend a few minutes talking with my patients and explaining to them why "Expensiva" is not the best choice based on side effects, costs, or available randomized controlled trials. Yes, this does take a bit more time, and others might just give in and prescribe, but one of a physician's most important skills is communication.
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Exactly. I think it is a useful exercise. It puts a historical spin on a common approach to teaching medicine (case studies/problem based learning), making it a bit more interesting. Believe me, after you have heard the 100th case presentation about Mr. X, who presents to the ER with X complaint...thinking about how to treat Mr. Lincoln with today's technology would be a welcome respite.
I look at it as not so much "would he have done better," but thinking about how we would actually care for Mr. Lincoln with what we have available now for head trauma - early airway management, prevention of hyperventilation, active cooling, etc.
I have been running Vista since December I can assure you that oddball dialogs like the parent is describing do occur - seemingly without reason. I am running the RTM, not a beta, and I frequently get the same behavior. For example, yesterday I tried to move a file from one directory to another on the same drive, with correct permissions, and I was told I needed to have administrator privileges to perform the operation. Well, fine - but the UAC would not open a dialog to allow me to enter the administrator credentials. Color me puzzled, but it did allow me to copy the folder and then delete it from the original directory with no objection.
This is the kind of useless behavior that will cause the average user to turn off UAC without a second thought.
You know it is funny (in a sad way), but during medical school we were taught that the average physician interrupts the patient within 30 seconds of the start of the conversation and starts asking yes/no questions. Unfortunately we (physicians), tend to miss many of the important bits of information because of that, and the average patient only talks for about 2 minutes if you just sit and listen. Miraculously, I have discovered that if you listen for that extra 1:30, you tend to save yourself a great deal of time ordering tests, drugs, etc. In my experience, patient visits tend to be handled much faster by listening for 2 minutes, asking a few open-ended questions to fill in the blanks, and parting ways with satisfaction rather than misunderstanding and unhappiness.
If I can explain something in 2 minutes rather than spend 5 minutes ordering a drug or test, everyone wins. Of course, this does not always happen, and sometimes the picture is less than clear when I leave a room...but a little extra time spent talking seems to save a lot of time in the end.
Take, for example, the common scenario of the vomiting child. Parents worried, me busy...now I can simply say, "yup, your child is vomiting, we'll give some *insert expensive anti-vomiting medication* and an IV," or I can spend a few minutes explaining the WHO process of giving small amounts (1 tsp or so) of fluid every few minutes so that the child will not vomit, explain how to limit the diet a bit for the next couple of days, and let the parents ask a few questions. In the end, the medication and IV takes an hour+ to accomplish, or the parents spend 1/2 hour giving small amounts of fluid that add up quickly. Either way (usually) the child's mild dehydration gets treated...and with a little more talking up front, I save 1/2 hour down the line.
I am the first to admit physicians get lulled into a "drug for every disease" pattern, but the truth is, a little time, reassurance and education will solve the majority of problems. The trick is knowing which problems that approach won't solve...but that's why I went to med school in the first place (and a topic for another day).
IAAD, and I think you have a very valid point. Most of the drugs advertised on television here in the US are high dollar moneymakers for the pharma companies. In my opinion, this is the biggest problem - the vast majority of the time, much cheaper generic medications which are equivalent (or sometimes superior) in efficacy are available. The ads are just marketing and serve to drive up the already astronomical price of healthcare in the US. Personally, I usually ignore requests and spend a few minutes talking with my patients and explaining to them why "Expensiva" is not the best choice based on side effects, costs, or available randomized controlled trials. Yes, this does take a bit more time, and others might just give in and prescribe, but one of a physician's most important skills is communication.