Here’s a Toast to Change for Valentine’s Day

Yesterday one of the residents found an antique in the staff consult office and wondered if I had ever used it. It’s an old dictaphone which faculty and residents no doubt used back in the day to dictate clinical notes.

It was quite a gadget and though I never used that model, I did have a smaller and more modern one that used cassette tapes as well. The resident pointed out you can’t buy the tapes anymore. I mumbled something about my old 8 track player that has been long gone to the landfill, which I don’t think she heard. Nowadays, if you don’t care what your notes say, you dictate using Dragon Naturally Speaking, a voice recognition software that doesn’t recognize anyone’s voice. I began using it again in the summer of 2012 and quit in disgust by September. I believe it’s up to version 1300 by now, which I’m sure has not improved its performance one iota.

Still looking for a dragon to slay.
Still looking for a dragon to slay.

The old is always being replaced by the new and it’s a darn good thing. Next month our Psychosomatic Medicine Interest Group (PMIG) will be moving our meetings to a new conference room.

The portraits on the walls of the old conference room are of past department chairs. There are short bios Past Chairs UIHC Psych Dept in the University of Iowa Psychiatry Department booklet, Then & Now 1919-2009, The 90th Anniversary of The University of Iowa Psychiatric Hospital. They were very interesting men and I hope that the coming years will usher in even more interesting women leaders who have just as much vision and tenacity in the next 90 years.

I have also noticed the change in the medical students rotating on the psychiatry consultation service. They are entering clinical rotations in the second year and the other day I noticed that when I wondered aloud how commonly antipsychotics can be associated with hypothermia, one of them had the answer almost instantly simply by googling it on his iPhone.

That is just further evidence how out of touch the specialty certification boards are as they keep pushing Maintenance of Certification (MOC) at physicians and residents. The recertification exams, performance in practice and self-assessment modules are not how doctors learn anymore. The MOC was antiquated almost as soon as it got started. However, as I compare the number of signatures on Dr. Paul Teirstein’s petition opposing the American Board of Internal Medicine (ABIM) MOC a couple of years ago to the new one sponsored by another group of MOC opponents, I can see that the level of enthusiasm for a revolution to reform MOC may be waning.

I think of Dr. Teirstein as the Bernie Sanders of the MOC reform movement. Maybe Bernie should have a look at the issue. I’m pretty sure he would see the whole business as corrupt and rigged. However, the structure of the medical boards is such that it’s difficult to get energized about overturning the wasteful, busywork MOC because there is no authority above the American Board of Medical Specialties (ABMS) which drives the whole machine.  Doctors don’t feel heard, have no power over a system which in effect abuses them and this has a pronounced influence on the burnout epidemic in physicians in many specialties.

The struggle continues in many places. Michigan is one of the hot spots where the Right2Care initiative is picking up speed. Resignation and inertia are the chief obstacles to overcome.

I suspect it will change. Everything does. Even Valentine’s Day has changed over time. It used to be marked by slapping women with strips of animal hide dipped in sacrificial blood. It didn’t start with Hallmark.

Have a happy Valentine’s Day tomorrow and here’s a toast to change.

Jim and Sena Niagara Valentine

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