A Vital Synapse

After a few years of practice, I have come to realize that hospital medicine lacks a crucial component in the reinforcement of knowledge that was unconsciously available to the forefathers who practiced traditional internal medicine. In the past, an internist would investigate and treat a patient in the hospital. He would particularly ponder over puzzling cases and implement a treatment plan. Often, patients would be discharged before the full effect and results of the treatment plan could be actualized — patients would be discharged once they started improving, not necessarily when they were cured. A traditional internist would have the benefit of following up with the patient days or weeks later, to see how the patient was doing and also to find out whether their treatment strategy in the hospital had actually worked. Here lies the difference. Having this follow-up encounter reinforces learning and memory because it provides a provocative conclusion to an incompletely answered question. When the same set of symptoms arises in a future patient encounter, there is more confidence in your treatment plan as you can easily recall a similar patient who you had a “closed-loop” encounter with. Unfortunately, most hospitalists today lack that opportunity to follow up with patients and thus, miss the chance to close the loop, and just as importantly, they miss the chance to form that vital learning synapse.