The Journal of the Arkansas Medical Society, Vol 115, No. 9 Med Journal March 2019 Final 2 | Page 5

Tobias Vancil, MD, FACP COMMENTARY It’s Hard to Envision the Future While Constantly Reviewing the Past M y wife and I recently took a vacation to Co- lombia; yes, Colombia. When telling family and colleagues our plans, there was a similar look of consternation on ev- eryone’s face. The next most common response was, “Isn’t that dangerous?” I even had a patient tell me the day before we left, “Don’t you know that country’s government is corrupt and terri- bly dysfunctional?!” (The irony, of course, was that his statement was made in the midst of a prolonged government shutdown right here at home, with political parties paralyzed by scandal and the inability to compromise.) The truth is that Colombia has made great strides over the last decade and has become a frequent travel destination for people from all over the globe. In fact, Medellin (yes, the city most notorious for the crime and devastation of the Escobar Cartel days) was voted the most in- novative city in the world in 2013. In doing so, it beat out Tel Aviv and New York with develop- ments in urban planning and cultural insight. What did city leaders do to deserve this? They used multiple methods of new public transpor- tation to bring together a community of citizens that were previously isolated from both entering the city center easily and from getting organized police protection in their borough due to a chal- lenging topographical terrain. These new trans- portation methods include a large north/south and east/west transit train; smaller trams out from the main transit line; and escalators and cable cars to assist with ascending/descend- ing steep hillsides that previously would take a significant endeavor to conquer. What previ- ously might have taken a typical citizen several hours in transit each day for work, now can be accomplished in a matter of time that would be considered a reasonable commute. When you ask people in this city how this progress can be made so quickly in the shadow of a recent vio- lent past, they would say, “You can’t dwell on the past, you can only acknowledge your history and move on.” How is this important to the practice of medicine? Well, like many of you, I spend a sig- nificant amount of time every month in meeting rooms combing over data from last month, last quarter, and last year. We are assessing length of stay for inpatients, dynamics surrounding re-ad- mission rates, and workflows in various patient care settings. This is clearly a necessary evil, as we often identify areas for quality improvement measures to be implemented and maybe even an unnoticed change in workflow that alters efficiency. As an educator of residents, I attend regular meetings to review cases and assess the outcomes of particular cases based on plans of care. Again, this is necessary for identifying areas of improvement. As a teacher of medical students, I am involved in group discussions to recognize ways of teaching an ever-changing style of learners on our local level, but globally the literature continues to look back and discuss the Flexner report and “the way it was.” time in small groups discussing our vision for the future as a medical society. In doing so, we came up with ideas regarding possible political efforts, educational endeavors, and how we can work as a collective group of physicians to combat im- pending obstacles. Within these groups, we were no longer specialists, surgeons, or primary care providers. Instead, we were doctors focusing on the future without dwelling on the past. While precious time to sit and ponder is not something many of us have an abundance of, I encourage all of us to use at least some of this time to think about the future of our practice and innovations that can be implemented to directly address pa- tient care moving ever forward. A lesson learned from those with less to take for granted. Put your business or service in the hands of 4,400 Arkansas physicians. While all these areas of reflection are impor- tant, we need to accept the reality that the individ- ual patient sitting in front of you today sees little- to-no benefit in our length-of-stay data moving a decimal point and our learners (who are chang- ing more rapidly than ever as technology allows for easier dissemination of resources) will likely obtain zero benefit from another re-assessment of the teaching methods employed decades ago. Let’s not dwell on these aspects of our past, but rather acknowledge them and spend more time focusing on innovation for the future. Now, I am not pretending to have a list of solutions just waiting to be implemented, but maybe it is time to “reinvent the wheel,” which is something people have been urging me not to do as far back as high school. At our most recent AMS meeting in Heber Springs, we spent For more advertising information, contact Penny Henderson at 501.224.8967 or [email protected] NUMBER 9 MARCH 2019 • 197