Le works to transform the system

Medical student Tam Le delves into the intricacies of the U.S. health care system to help inform how medical students and residents are trained on the job.

By Jamie Williams, jamie.williams@unchealth.unc.edu

Tam Le is a first-generation Vietnamese American who, as a teenager in Cary, became interested in North Carolina’s Hispanic population – an interest that started her on her current path toward becoming a doctor. The Hispanic immigrant stories she heard echoed some of the ones she heard from her parents, who came to the United States in the 1970s.

As an undergraduate at UNC, Le became fluent in Spanish, worked as an English tutor for ESL students, and volunteered for Big Brothers, Big Sisters. She also became active in the UNC group Farmworker Health Alliance, which sends undergraduates to Benson, North Carolina, to help educate farmworkers in the state about health management and disease prevention, as well as to provide information about local health care resources.

“Speaking with farmworkers every week, taking their patient histories, and just learning about their needs was an experience that made me want to become a physician,” Le said.

Now in her third year at the UNC School of Medicine, Le has decided to dig into the subject of health care costs and accessibility.

“Affordability in health care is such a major challenge for the immigrant community – and for everyone, really,” Le said. “I wanted to take some time to focus on this and really try to learn about what contributes to the high cost of health care.”

Once she dove in, she said her days were spent on the phone with insurance companies and in communication with McLendon labs here at UNC. She wanted to understand everything.

“The more I learned, the more questions I had,” Le said.

She began to work with Richard Wardrop, MD, PhD, associate professor of pediatrics and director of the internal medicine-pediatrics residency program. Wardrop is a leader in the research and development of best practices in High Value Care, a practice philosophy supported by the American College of Physicians. He called Le’s passion for the subject “atypical.”

“I’ve worked with students in the past who have been interested in this topic, but Tam is incredibly passionate,” Wardrop said. “I really think this work will be part of her career moving forward.”

High Value Care is a philosophy that discourages the overuse of tests and treatments that do not demonstrably improve patient outcomes. The dual aim is to improve patient care while also minimizing health care costs. Training in High Value Care became part of the UNC School of Medicine’s transition clerkship in 2014.

“This is still new for many people and Tam immediately took a great interest in seeing how these principles are being translated into the clinical setting,” Wardrop said. “Because that is of course where the rubber meets the road.”

With High Value Care now being taught to medical students, Le and Wardrop knew that residents would also benefit from greater exposure to the subject. In response to this need, they have worked together on an initiative designed to raise cost consciousness among residents.

During morning reports, a case is presented and residents have opportunities to make orders for tests.

Le developed a piece of software with Byron C. Jaeger to ease data collection and also provide instantaneous feedback for participants. During breaks in morning report lectures, residents can use their smartphones to order any tests that they feel are necessary. Following the lecture, the cost and efficacy of the potential tests are discussed. Le’s software program then generates an individualized report, allowing participants to compare their decisions to the group and also track them over time.

The interactive learning activity has been held monthly and Le says it has been well received.

It has also attracted attention from physicians across the state. Le recently presented the work at a meeting of the North Carolina Chapter of the American College of Physicians and was named “Best Student” in that organization’s annual poster competition. In May, she will travel to Washington, D.C., to present at the American College of Physicians’ national meeting.   

Le said that she knows this focus on the inner workings of health care will make her a better physician. She plans to go into family medicine and hopes to serve underserved populations.

“I just want to know as much as I can,” Le said. “All of this will only allow me to be better prepared for questions from my patients.”

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