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“I love the idea that everybody has a role to play in improving healthcare quality.”

Brian S. McGowan, PhD is a research scientist who has worked as a medical educator, mentor, accredited provider, and commercial supporter. Brian S. McGowan, PhD taught Medical Physiology at Arcadia University, served as Senior Director IME at Wyeth Pharmaceuticals, and Director of the Oncology Medical Education Group at Pfizer, Inc.

Brian is the author of the Social Media Connections Column for Medical Meetings Magazine and is writing a book on the need for fundamental elements in the medical information stream.

MO: You have a passion for continuing medical education. How has working as both an educator and a medical scientist contributed to this passion?

Brian S. McGowan, PhD:  It is a passion for sure, considering all of the pressures being applied to the healthcare system in general and the medical professionals more specifically, there is an unprecedented opportunity to have a real significant impact on healthcare quality – all we need to do is 1) support the way information flows to physicians and 2) engineer some tools that help physicians use this information more efficiently. But we may have to break a few eggs along the way. It seems there are a few people and groups who are determined to defend the status quo regardless of the impending crisis.

The medical scientist bubbles up to service a few times a day – it is amazing how little good data we have on how physicians seek information, how they learn, and how they make decisions. We have lots of assumptions, lots of opinions, and a fair amount of bad data, but very little good data directs the way we support the life-long learning of physicians. If I learned anything from my years in a research lab it was “bad data is worse than no data.” I don’t think many people understand this – I have seen a lot of folks worship a p-value, with no understanding of how it was calculated. Again, in my mind, there is too much on the line to accept this any longer.

MO:  How can professionals outside the healthcare industry contribute to the effort to improving health care and continuing education?

Brian S. McGowan, PhD:  This is a great question. I love the idea that everybody has a role to play in improving healthcare quality. My first thought is that we all need to take greater control over our health – but clearly this is easier said than done.
My second thought is that we each need to take greater control over our health data – maybe this is a bit more approachable. For example, from 2003 to 2009 my father struggled with chronic angina. He started treatment in Pennsylvania, retired to Florida and had to find all new doctors and basically start over, and then several years later, while on vacation in Washington, he was rushed to the emergency room and then to the catheterization (probably should spell it out for those who don’t know what a “cath lab” is)lab. Three states, three cardiologists – and there was very little information being shared between the systems. But he had documented everything in a excel spreadsheet. Looking back he can tell me the time and date of every symptom – this is the ultimate empowerment.

And, my third thought is that we each need to feel empowered to find a community of patients with whom we can share and learn. No one practices being a patient, but being an effective patient may have as large a role in your health outcomes as having access to a world-class healthcare system. This third thought might not work for everyone, but for those who can, this is a powerful contribution to make.

MO:  In your upcoming book you focus on elements of the information stream between all parties in the industry, where do you see problems in the way information is passed?

Brian S. McGowan, PhD:  The system is broken and fragmented – and that is not just my opinion that is what the Institute of Medicine concluded. Medical Associations have been too slow to adapt to the rate at which information can now flow. Their meetings are poorly suited for learning, their structure and governance undermine any semblance of continuous improvement, and the journals they publish have followed the lead of for–profit publishers such that excluding access to new medical information is consider an acceptable business practice.

We need to aggregate information and data in new ways. We need new models of open science and new models of open access. And then we need to support the dissemination, transfer, and translation of this information into knowledge and action.

The reality is that I could spend hours answering this question because the medical community has failed to update their processes and technology in decades. Recently entrepreneurs have had to step up and try to satiate a very anxious, highly innovative physician community who sees that change is needed, but also sees that the ‘house of medicine’ has by-and-large failed to meet that need. The result is that we have introduced even greater complexity into the system. As Einstein said, ‘anyone can make a system larger and more complex, only a genius can do the opposite.’ And we are in desperate need of some genius thinking.

MO:  In your column in Medical Meetings Magazine, you touch on your hypothesis that doctors should use social media in three separate ways. On the other side, how would you recommend patients use social media for health care information?

Brian S. McGowan, PhD:  Patients have a great opportunity to ask questions and do their own research – to be empowered and to support their own care. Social media offers novel access to new networks of patients with whom we may be sharing a similar journey. But there are some major challenges herein. Most patients have not had to manage the types of virtual relationships that social media offers – sure they may have hundreds of friends on Facebook, but they have probably known these people for years before ‘in real life’. When patients are forced to build new virtual relationships they can quickly get sucked into a vortex in which they don’t know what to believe. I think there are five new skills that we each are going to need to develop in the next few years to make sense of these new open, connected, and social channels:

1. We must assess the credibility of information and the reputation of people more effectively

2. We must filter, curate, and search pertinent health information more efficiently

3. We must provide and accept feedback from the ‘community’ without attacking and without getting defensive and shutting down – there are some very blunt conversations that patients often find themselves having.

4. We must become experts in assessing our ‘topic literacy’ – this means that to craft the right question and contribute to the social media dialogue we have to be very accurate in assessing what we know and what we do not know.

5. And finally, we must evolve our critical thinking and decision making skills – this is not easy, but since few patients will ever know as much about their condition as their healthcare team, the patient must be able bring to the table a common sense and rational approach to decision making.

MO:  With technology only improving, do you see information becoming more easily consumable for patients or the amount of information creating only more confusion?

Brian S. McGowan, PhD:
It all depends on what we do with the data. Clearly, we are just at the beginning of the data dump. In the next three to five years we will have all kinds of new data sources feeding into the data stream, including the advent of the three billion base pair individualized genomics analysis. If there are no system enhancements built to aggregate and simplify this data, we will have a bottleneck that is conceivably three billion times worse than today.

We need a systems architecture that does something with this data. For physicians we need interoperable electronic health records, for patients we need interoperable patient health records. I do believe that this will happen, because there is no other conceivable solution…but I am fairly certain that the solution DOES NOT already exist.

MO:  Throughout your career you have worked for multiple pharmaceutical companies on the education side. What kind of responsibility do these companies have in the push for better health care?

Brian S. McGowan, PhD:  The party line has been the same for the last few years – the more informed and knowledgeable the healthcare professional, the more likely they will be to provide the best care for their patients. And following that logic tree – if pharmaceutical companies have brought effective products to market, then the informed healthcare professionals will be more likely to use these products. But for the pharmaceutical companies it does, without exception, always come back to their products. If the needs of patients and the healthcare community align with the business interest of the pharmaceutical companies, then a convergent relationship can form – the proverbial win-win-win. But when this alignment is not the reality – and it rarely is – then pharma should not be interfering. So if you ask about responsibility – I think the only responsibility pharmaceutical companies have is to their shareholders and to think otherwise is a bit naïve.

MO: At the end of the day, what is one thing each person can do to help improve our country’s health care situation?

Brian S. McGowan, PhD:  In general, there are two solutions that are constantly being marched out as fixes for the healthcare quality crisis. The first is for Washington to make some significant policy changes that fundamentally reshape the way healthcare is provided. This is logical, but in our two-party government system, there is no way that this will ever succeed. The second is to provide health-related education for everyone – that by teaching the general public about serving size, portion control, the dangers of smoking, and the need for exercise we will each be able to make better decisions. And that is obviously not working so well – there is simply no way that we can separately educate 300 million individuals to solve their own problems.

The only practical solution is to empower individuals to find communities and collaborative models for healthcare that share responsibility. I think of this as a Goldilocks solution – policy is too big to get passed, education is too small to affect change, but building new communities for health and wellness is just right. But first these communities need to be engineered and that is something we are just beginning to get our heads around.

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