Time away from the office an investment in the time spent in it

Politicians have markedly disparate visions for the government's role in health care. The outcomes of the 2012 elections will have an impact on what eventually happens.A recap of events at Internal Medicine 2011 provide insights into clinical knowledge and the problems facing internal medicine.

These days, traveling more than ever, I work to keep my e-mail inbox and EHR in-basket contained while I'm out of town. I have my office discard the extraneous snail mail to shrink the in-tray, and this time, after eight days away, I caught an early-morning flight on Sunday to have a few hours in the office before the new week began.

But once again, in no time at all, the day-to-day needs of office, hospital and home consumed my time, attention and energy. Had Internal Medicine 2011 in San Diego just been a dream? Did I remember any of the valuable information I'd heard? Was it worth the time and expense? The answers came fast and clearly: No, some and emphatically yes.

It was an invigorating week. Nine thousand attendees participated in over 250 scientific sessions presented in multiple formats: clinical pearls, meet the professor, role plays, panels and skills workshops. I had wanted to go to them all, but this year, with my time almost fully occupied by governance activities, I managed only a few. So snatching a last chance to upgrade my knowledge, I attended the gem-filled highlights of Saturday's closing session, and then subsequently downloaded the handouts. One of the highlights session's three presenters rightly pointed out that you only retain what you hear for 32 minutes.

The presentation also reminded me of how quickly much of our carefully learned information becomes obsolete. What we need is not to memorize the latest facts, but to get them as close to the point of care as possible. As well as “practice-based learning and improvement,” internists need improved techniques for “systems-based practice.” The College is diligently working to provide just that.

What I missed by not attending the primary lectures was that hard-to-quantify gestalt that comes from hearing how new knowledge and techniques emerge from the developing understanding of pathophysiology. This is the foundation to which we always return, to make the best decisions for our patients when available evidence is inadequate.

Internal Medicine 2011 was more than a place to acquire a few pertinent facts. It was an opportunity to meet colleagues, reconnect with students, residents and physicians in other institutions, and become acquainted with new people. Walking along the waterfront from hotel to convention center, I learned that one internist was attending because she had recently joined a rural practice with several family practitioners and had become the group's consultant for most internal medicine issues.

Another casual conversation revealed that many physicians are facing the daunting task of how to care for people living in the U.S. without documentation. What does one do for a person with stage 5 chronic kidney disease who will soon need life-sustaining services that are not available to him or her? It was another sobering reminder that restricting access to health insurance will not prevent people from being sick or needing health care. Nor does it relieve the physician's obligation to provide care. In April, the College released a position paper addressing health care for immigrants, advocating for a national policy.

The annual meeting's offerings for young physicians, associates and students are always particularly exciting. The Leadership Enhancement and Development (LEAD) Program, in its fourth year, provided 20 sessions that resulted in 26 young members earning a certificate, positioning them to take on leadership roles in their own organizations, communities and the College.

It was gratifying to see that associates submitted 417 research and 2,155 clinical vignette abstracts. From these and ACP chapter winners, 20 oral and 425 poster presentations resulted in 20 research and 20 vignette winners. Medical students were not far behind with 84 research and 166 vignette submissions, 46 research and 46 vignette presentations and a total of 10 winners from each group.

It was a great pleasure to celebrate on Saturday evening with all the participants and winners as the meeting's final event. The ACP Council of Student Members, Council of Associates and Council of Young Physicians deserve much kudos for their contribution to these programs, as do the staff and the participating College members, 256 of whom served as review board judges and 270 as on-site judges. Next year, please consider volunteering for this rewarding activity, which is so critical for engaging those who are the future of our profession.

Another satisfying aspect of the annual meeting was the opportunity to exchange ideas with leaders of internal medicine's global community. It has become more and more apparent that while each internal medicine organization and health care system faces country- or region-specific concerns, the major challenges are common to us all.

The main workforce issues are the imbalance between subspecialist and generalist internists, along with inadequate numbers of those providing primary care services. Of course, escalating costs trump all other forces. We once again confirmed that we have much to do separately and together to influence policymakers, payers, clinicians and educators to promote more effective systems of care and realign incentives to improve value for individual patients and societies.

The annual meeting also provided an opportunity to hear from and celebrate with our international members, now in 13 chapters and 128 countries. At convocation, five international Fellows were awarded Mastership, a distinguished honor and 100 Members became new Fellows, 30 from countries with chapters and 70 from 20 countries without chapters. Congratulations to all new Masters and Fellows.

The benefits of that week in April will unquestionably inform, enhance and guide my patient care and advocacy activities this year. I trust you will all join me in these efforts over the coming months and in New Orleans in 2012 for reinvigoration—laissez les bons temps rouler. But before then, we have much work to do to take on the challenges of promoting excellence and professionalism in the practice of medicine for the well-being of our patients.