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Medicine X | ED founder Larry Chu on the need to rethink health-care education

Saturday morning marks the start of this year's Medicine X | ED, an event that was born from the popular Medicine X conference and that explores the future of health-care education. In anticipation of the event, I recently talked with Stanford anesthesiologist Larry Chu, MD, founder and director of Medicine X.

What’s the origin story of Medicine X | ED? 

At our fall conference, we kept seeing the same misconceptions, year in and year out. We realized that if we were really going to change health care, we had to start much earlier in the process, before people become providers, before people become patients. We wondered: What if there were a conference in which we rethought the entire notion of health-care education, one in which we operated on the “everyone included” vision, this idea that all health-care stakeholders have something to contribute? If we’re going to really advance and create the health-care system we want, then we have to change the way we’re educating and teaching the people that work and live in that system.

People will be bringing a range of perspectives and priorities to Medicine X | ED. What are the high-priority changes you, personally, would like to make to health-care education?

First, inter-professional, interdisciplinary, team-based collaboration is essential to the future of our functioning health-care system. And we can’t get there if we’re not learning and teaching together. In health care, we learn in silos. Medical doctors train in medical school, and we don’t know anything about pharmacists. Pharmacists train at pharmacy school. They tend not to know anything about nurses. Nurses train at nursing school. They don’t know anything about occupational therapists. Yet when we’re all done, we’re expected to work together. We’re expected to form a team for the benefit of the patient.

I think the other change that needs to happen is a shift toward flattening power hierarchies and elevating respect hierarchies. And that really means spending time in our curriculum to understand the misperceptions that arise between the patient persona and the provider persona, so that we can uncover the roadblocks to honest conversation that get in the way of participatory health care decisions. We can’t have honest conversations if we don’t have trust, and we don’t have trust in our relationships because we don’t understand each other.

Understanding how to effectively use technology to engage today’s learners is another aspect of medical education that we need to accelerate quickly. We know that millennials are wired to learn differently. Yet medical educators today unfortunately make the assumption that what worked for them when they were students should work for today’s learners.

If we were able to implement some of these changes right away, how might the patient experience be different in 10 years? What kind of provider might we encounter?

The provider of the future is one who will meet you around a table on equal footing. He or she is going to be a collaborative partner — one who will ask questions, not just write orders. “How are we going to work on this together?” Not, “Why didn’t you take your blood pressure medicine?”

More importantly, the provider of the future is going to be incredibly knowledgeable about the many options that surround patient life, including the role of the pharmacist, the occupational therapist, the nursing resources — because, again, it’s about inter-professional teams. In fact, I would say that the relationship isn’t centered around the medical doctor.

Why is right now the moment to make these changes?

That’s interesting. I guess part of it was explained by Lindred Greer’s keynote address at Medicine X 2016, in which she discussed organizational leadership and hierarchy. One of the things she mentioned is that organizations that are very hierarchal reach decisions quickly, and sometimes hierarchy is a good thing. Like when you’re lying on the ground and you have no pulse and somebody has to get your heart started again quickly, you want hierarchy. Right? I think, at its essence, that’s how health care has been organized since the old, old days.

What’s changed is, first of all, health care has become so complex. Skills are so specialized. Collaboration is not a nice-to-have, it’s a must-have. And therefore we’re moving toward team-based approaches. And as Lindred mentioned, diverse teams that have considerate leadership tend to show the most creative approach. They might not reach the fastest decisions, but they generate the most innovative decisions — and that’s been part of the problem with health care. It hasn’t been innovative.

Lastly, we’re shifting the model because there’s a whole generation of new tools — digital health, data that’s coming in and empowering the end user to take control and to be more collaborative. And we’re realizing that costs have become so out of control that the old model of paternalistic medicine, of hierarchical medicine, is unsustainable. It doesn’t work. We have to create a model of engagement where people want to participate, and want to engage, so that there’s buy-in and personal responsibility.

Previously: Medicine X | ED explores the future of medical education in April 22-23 event and Improving communication in health care: A preview of Med X | ED
Photo of Larry Chu courtesy of Stanford Medicine X

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