For Your Health
For Your Health

News from the University of North Dakota School of Medicine & Health Sciences

From the Dean: The evolution of patient care

Susan and I recently attended a continuing medical education (CME) course in cardiology sponsored by the Mayo Clinic. As you probably know, CME credits are required for physicians and other healthcare providers to maintain their state licenses to practice and deliver clinical care. We’ve been to prior Mayo Clinic CME courses and – editorial comment – they are consistently excellent.

As I reflect on the course, two impressions stand out. The first relates to a hot topic in the lay press, and that is the rapidly burgeoning field of artificial intelligence (AI). The second is the real dilemma we as providers face as medical knowledge advances and often results in changes in what had been standard and accepted practice. I’ve touched on both of these themes in prior columns, but both were so evident during the recent CME session that I’d like to offer some additional thoughts on each.

As far as AI goes, Dr. Demilade Adedinsewo, a Mayo Clinic faculty member and presenter, gave a fascinating talk on how AI is being used today at the Mayo Clinic. It turns out that after she and her colleagues used AI to analyze up to seven million electrocardiograms, the technology was able to predict various conditions such as coronary artery disease, valvular heart disease, heart muscle disease (cardiomyopathy), liver scarring (cirrhosis), and other conditions – all based on a single (or several) patient electrocardiogram(s). Importantly, this is not simply a research protocol, but is available to clinicians taking care of patients in the clinic or hospital. The algorithm is integrated into Mayo Clinic’s electronic health record (EHR) computer system; they use Epic, the most common EHR in the U.S. All a clinician has to do is click on the “AI” button, and the EHR will predict the likelihood of the disease in question with remarkable accuracy. Truly amazing – and it’s an example of why UND and the SMHS are actively pursuing strategies to enhance our own development of AI for biomedical research, clinical education, and patient care.

The second strong impression I had at the end of the meeting was how important it is for clinicians to engage in life-long (or at least practice-long) education. So many things change as better and larger clinical trial results are disseminated, new discoveries are made in the laboratory, and better devices and pharmaceuticals are developed to help care for patients. The most obvious challenge is that practitioners must stay up-to-date as far as their medical knowledge. That requires an ongoing commitment to CME in one form or another.

The larger and more daunting challenge – and one I’ve discussed before – is how to guarantee we are delivering the most current care to our patients without confusing them. As we get newer and better scientific data and improved devices and medicines, our management strategies can change, sometimes going in the opposite direction of how we did things before. This can be confusing and demoralizing for our patients, for sure. But we also can’t get stuck in the past and keep doing things even when newer and better data indicate the need to change course. Discussing such changing management strategies with patients in an open and honest manner is essential to make sure they are fully engaged and informed about their medical management. It surely can be confusing for patients, though, when, for example, I have to tell them that they no longer need to take the aspirin they’ve been taking for 20 years because the practice guidelines have changed, based on newer and more robust data. As I’ve indicated before, it seems to me the only way to help patients navigate these management changes is by open discussion. The term that is often used in this regard is shared decision-making, which I heartily endorse. In this era of considerable doubt by the general public of “official” pronouncements, it is essential that we as healthcare providers interact with and engage our patients as individuals.

Joshua Wynne, MD, MBA, MPH
Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences