brigham and women’s

RECENT POSTS

Surgeon’s Death Spurs Painful Debate On Docs As ‘Face Of Health Care System’

Flowers are left outside the Brigham in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Flowers are left outside the Brigham last week in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Shocked and saddened by last week’s shooting at Brigham and Women’s Hospital, Dr. Miranda Fielding wrote a blog post that appeared on KevinMD, a popular site that gets 5 million clicks a month: “The Legacy of Dr. Michael Davidson.”

KevinMD, as founder Dr. Kevin Pho puts it, aims “to share the stories of the many who intersect with our health care system, but are rarely heard from,” including practicing physicians. He adds: “The public often doesn’t know what it’s like to work in our health system. KevinMD.com gives them an unfiltered view of our world.”

Dr. Michael Davidson (Courtesy of Brigham and Women’s Hospital)

Dr. Michael Davidson (Courtesy of Brigham and Women’s Hospital)

In the case of Dr. Fielding’s post, that unfiltered view reveals not only deep pain at a distinguished colleague’s death but also a far broader discomfort with serving, as one commenter puts it, as “the face of the health care system” — a system that sometimes harms patients, medically or financially.

In her post, Miranda Fielding — the pen name of a California-based radiation oncologist who blogs at The Crab Diaries — recalls from her own professional past a gentle colleague who was viciously beaten by a former patient, and writes:

When we graduate from medical school, we take the Hippocratic Oath, which in the modern version not only exhorts us to heal the sick, but to exhibit warmth, sympathy, and understanding. Let our patients and their families extend those same traits to us as we complete our daily rounds. Let our clinics and hospitals be places of healing, and not of killing. Please let us do our jobs.

I only wish that I had the answers to the groundswell of anger, frustration and resentment voiced in the comments on my blog.

– Dr. Miranda Fielding

Her post has been shared on Facebook more than 40,000 times, and sparked more than 150 comments. The post, Dr. Pho emailed, “clearly touched a nerve with my audience and highlights the sacrifice that health professionals make every day.”

But the response to the post highlights more systemic issues as well. Among the comments, the most popular, by a writer identified only as “guest,” refers in part to the report that the alleged Brigham shooter had complained in the past about a medical bill for the heart attack that killed his father:

What we as a profession appear to be (willfully) unaware of is that we doctors are the face of the healthcare system. To the extent that we do not speak up, protest and advocate for our patients when they are taken advantage of by hospitals and insurers, we provide a face for patients to blame. Anyone who doesn’t think that corporate executives and hospital administrators take full advantage of the opportunity to hide behind us as they maximize profits at the expense of our patients, is a fool.

We may think that because we go through our days bathed in an aura of self-righteous goodness (Look how we’re the smartest person in the room! How hard we work! How little sleep we get! How many of our child’s soccer games we’ve missed in order to care for our patients! How we do all this without even mentioning it to our patients, because that’s how good we are!), that that is how our patients see us as well.

But they don’t. They see the fancy cars in the parking lot, the children going to elite prep schools, the expensive hobbies like equestrianism, the hospital system charging $8,000 for a 15 minute emergency room visit that ended in death, the collection agency coming after a grieving family. And they blame us for not doing more.

Responded another commenter:

This is a horrible tragedy for all involved — him, his family, friends, colleagues and his other patients. And for other docs out there who are now more afraid. My heart aches for the victim of this violence and for all of us.

But you’re right. This did not happen in a vacuum. Continue reading

Widespread Chemical Bisphenol A Linked To Flawed Eggs In Women

Human egg

A human egg being injected with sperm (Eugene Ermolovich on Wikimedia Commons)

More bad news about Bisphenol A, the all-but-ubiquitous chemical used in plastic bottles and other products:

Researchers at Brigham and Women’s Hospital report today that Bisphenol A may contribute to  female infertility, based on their findings that in the lab, unfertilized human eggs exposed to high concentrations of BPA are significantly more likely to mature abnormally. From the press release:

“To our knowledge, this is the first study that has shown that BPA has a direct effect on egg maturation in humans,” said [lead researcher Dr. Catherine] Racowsky. “Because exposure to BPA is so ubiquitous, patients and medical professionals should be aware that BPA may cause a significant disruption to the fundamentals of the human reproductive process and may play a role in unexplained infertility.”

The randomized trial examined 352 eggs from 121 consenting patients at a fertility clinic. The eggs, which would have otherwise been discarded, were exposed to varying levels (20 ng/ml, 200 ng/ml and 20 µg/ml) of BPA in a laboratory setting. An egg from each patient was not exposed to BPA and served as the control. Researchers then examined the eggs and found that exposure to BPA caused:
· A decrease in the percentage of eggs that matured.
· An increase in the percentage of eggs that degenerated.
· An increase in the percentage of eggs that underwent spontaneous activation, the abnormal process when an egg acts as though it has been fertilized, even though it has not been.

Additionally, the eggs that were exposed to greater levels of BPA had a decreased likelihood of maturity, an increased likelihood of degeneration and an increased likelihood of spontaneous activation. Researchers note that these results are similar to the previous research examining the impact of BPA exposure on animal eggs.

Earlier research suggested that BPA may also be bad for male fertility: A 2010 paper in the journal Nature found that it could damage the DNA in sperm.

But not to panic. First, in an interview, Dr. Racowsky emphasized that this is very early research whose central message is that more research is needed — it is by no means ready for the clinic. Eventually, she said, it may help shed light on infertility in couples who have no other obvious reason for it. Continue reading

You Too Can Feel Like A Longwood M.D.-PhD, Or At Least Vote Like One

vote

I just voted.

No, not in that election. I just voted in a Brigham And Women’s Hospital research contest for a $100,000 prize to be announced Nov. 15. The voting deadline is tonight at midnight, and you, too, are welcome to weigh in here.

One of the contestants, Dr. Robert C. Green, contacted us to spread word of the contest and request support for his entry. Needless to say, my vote is secret but I can disclose that we’ve covered his work repeatedly, including a major first-of-its kind project to study how sequencing patients’ DNA can best be used in clinical practice. His proposal for the vote involves sequencing DNA in newborns: The day will soon be upon us when a baby’s full DNA can be analyzed at birth to determine future health risks. How do parents and pediatricians handle this information?

The competitors:”Using Electronic Health Records and Genetics to Personalize the Treatment of Multiple Sclerosis” and “Using Cutting-Edge Technology to Unravel the Mysteries of the Immune System.” You can watch videos of the contestants explaining their projects here.

Of course I feel very important helping to decide which august researchers get the prize money. But I also sent an email to a researcher friend headlined: “Is it me or is this kind of an odd way to decide who gets a prize??

“Odd,” he replied.

I mean, it’s one thing if it’s an online survey seeking votes on which celebrities are most popular. But isn’t research supposed to be “peer reviewed”? (Note: the projects were in fact peer-reviewed in advance by a Brigham senior-scientist committee before being put out to this public vote.) I hate to run myself down, but I strongly suspect I’m not a peer. Though it’s certainly fun to feel for a moment like a Longwood MD-PhD — all I need to really measure up is, er, a medical degree and a doctorate…

(Voted and feel like you still want more input? Info on the Brigham’s first annual open-to-the-public Research Day on Nov. 15 here.)

Texas Mom Approved For Double Arm Transplant At Brigham, Now Needs Donor

Katy Hayes and daughter

. (Photo via BWH)

This just in from Brigham and Women’s Hospital:

Boston, MA – Following completion of a rigorous pre-operative evaluation, Katy Hayes, of Kingwood, TX, has been approved by the Institutional Review Board at Brigham and Women’s Hospital (BWH) for a bilateral arm transplant. BWH is working in collaboration with the New England Organ Bank (NEOB) who will now actively search for an appropriate donor for Hayes.

Hayes, 43, who became a quadruple amputee in 2010 following a life threatening Group A Streptococcal (GAS) infection, will hold a press conference with her surgeons at BWH to share her story and discuss the procedure. She hopes to become the first in the nation to receive a bilateral arm transplant above the elbow.

See the Brigham’s full cornucopia of multi-media information, including photos, video, and fact-sheet, here. Here is Katy’s own blog, and here she is on the Anderson Cooper show last year.

Brigham & Women’s Visuals Of Double Hand Transplant

If you’re fascinated by the major, cutting-edge transplants done at Brigham and Women’s Hospital lately, check out their generous supply of visuals from the latest: a double hand transplant announced today.

The Brigham’s Webpage with an array of video and photos is here, and their “B-roll” video — footage meant as background for a voice-over — of the patient, Richard Mangino, and his transplant journey is here.

As you Age, A Drink A Day May Help Keep The Doctor Away

Just a quick note on my way to the package store:

In thousands of nurses, moderate drinking in mid-life appears to be linked to a healthier old age, according to a new study just published in the journal PLoS medicine.

Just joking about the package store. In fact, the study’s lead author, Dr. Qi Sun, an Instructor in Medicine at Brigham and Women’s Hospital and Harvard Medical School, says the study’s results still leave him cautious about recommending that non-drinkers take up the bottle, because other research has found that even moderate drinking may slightly raise the risk of breast cancer.

But the results do mean, he said, that in people who already drink moderately, the benefits may be significant. So, to put his quantitative analysis into my own words, “Cheers!” (And don’t forget that exercise and healthy weight maintenance have also been shown to lead to a healthier old age.)

The study fits in to a growing body of research that has found health benefits from “moderate” drinking equivalent to about one-third glass to one glass of wine per day. It did not distinguish between types of alcohol, but Qi said that the nurses in the study did tend to drink wine rather than beer or hard alcohol.

From the press release:

Researchers evaluated alcohol consumption during middle age in 121, 700 participants in BWH’s Nurses’ Health Study using data from food frequency questionnaires. They included participants who were not heavier drinkers when middle-aged and examined the health status in the 13,984 women who lived to 70 years and over. Continue reading

True Transparency: Doctors Who Admit Errors, And How To Help Them

A patient who had a different operation made things very clear...


It’s easy to be snarky. I confess that when I posted this story last November about a Mass. General surgeon who admitted performing the wrong operation on a patient and analyzed why, my headline began “Oops!” But the truth is, of course, its incredibly courageous of doctors to admit their mistakes publicly, to break the medical omerta.

The topic is timely today because of a new Harvard study finding that most doctors will face a malpractice lawsuit at some point — and interesting work under way in Massachusetts to encourage medical apologies. The Patrick administration, too, supports making admissions and apologies easier. And the American Medical Association’s amednews.com has just posted an inspiring piece on three doctors who came clean before their colleagues, including Mass. General’s Dr. David C. Ring and Dr. Jo Shapiro of Brigham & Women’s.

The piece begins with a heartbreaking story of a Seattle nurse whose dosage miscalculation led to a baby’s death — and to her own suicide. (A recent study found that doctors have about double the usual suicide rate to begin with, and major medical mistakes triple their suicide risk, amednews reports.) And the piece ends with some of the efforts, in Boston and elsewhere, to help medical staffers who have made errors:

Supporting physicians when things go wrong

Few physicians talk publicly about their medical errors, but a growing number are benefiting from programs dedicated to helping doctors deal with the emotional turmoil that often comes in the wake of adverse events.

Jo Shapiro, MD, helped start the Center for Professionalism & Peer Support at Boston’s Brigham and Women’s Hospital in October 2008. There are 55 physicians and other health professionals at the hospital trained to offer emotional support to peers involved in cases of patient harm.

“When there’s any kind of adverse event that we hear about, one of us will make an outreach call to the physician involved,” Dr. Shapiro says. “We ask them simple questions like, ‘How are you doing? How are you feeling? Is there anything I can do to help you?’ ”

Continue reading

Chimp Victim’s Face Transplant Photos Released: Then And Now

Wow. Words can never compete with these pictures, but here’s the release just in from Brigham and Women’s:

First Photo and Statement from Face Transplant Recipient Charla Nash is Released

Boston, MA – Brigham and Women’s Hospital has released the first post-surgery photograph of Charla Nash, who received a full face transplant in late May of this year at Brigham and Women’s Hospital. Nash was mauled by her friend’s chimp in Connecticut in 2009.

The following is a statement from Charla Nash:

Since February 16, 2009, I have been blessed to be in the care of many incredible doctors, nurses, and caregivers. These professionals first saved my life, then healed my wounds and strengthened me to face an uncertain future. They helped me adapt to a near impossible situation where I was unable to see, smell, and move with confidence without the use of hands. Finally, I was given the chance to restore most of what I lost by coming to Brigham and Women’s Hospital. Here I received a new face and two hands that will allow me to be independent once again and able to be part of society. Losing the new hands is just a bump in the road of my recovery. I believe that one day I’ll have two hands to help me live as a blind person with confidence.

I thank everyone who has helped me for these last two and a half years.

The first responders who arrived at the scene of the attack in Stamford were the first to see how injured I was, and the first to help me stay alive. Dr. Kevin Miller and his staff at Stamford Hospital performed life-saving surgery that first night. All the members of the medical team performed brilliantly. I was able to personally thank many members of that team, but I wish to once again express my gratitude. Continue reading

Breaking: 638 Brigham & Women’s Patients Warned That Doctor Lost Hard Drive

This release just in from Brigham and Women’s Hospital:

Brigham and Women’s Hospital Notifies 638 Patients of a Potential Data Breach
Device containing patient information lost

Boston, MA – An external hard drive belonging to a Brigham and Women’s/Faulkner Hospital (BW/F) physician was lost on June 21, 2011. BW/F has sent letters to notify the 638 patients whose medical information may have been on the device.

The following information related to inpatient hospital stays from July 10, 2009 to January 28, 2011, may have been present on the device: patient name, medical record number, dates of admission, medications and information about diagnosis and treatment. The information did not contain Social Security numbers, insurance numbers or other financial account information.

“BW/F takes the privacy and security of our patients’ information very seriously. We are taking steps to reduce the risk of such events occurring in the future, including addressing the incident specifically with those involved, reviewing and augmenting our policies and procedures, and enhancing our training regarding technical safeguards required on external hard drives that may contain sensitive data, as well as limiting the amount of data stored on such devices,” said Sue Schade, BW/F’s chief information officer.

“It is fortunate that no Social Security numbers or financial information were included in the information that was lost. We have no knowledge that the information on this device has been accessed. However, as a precaution, we are offering affected patients identity protection services,” said Schade. “We apologize for any inconvenience and deeply regret any concern this situation may cause our patients.”

Patients who require additional information, or have questions can call toll free at 877-694-3367.

I’m immediately cast back to the last big news story about a data breach: Those Massachusetts General Hospital records that were left on a subway. They included records of HIV patients. The hospital ultimately agreed in February to pay $1 million to settle claims that it had violated patient privacy. That story is here.

What baffles me is that both Mass. General and the Brigham have some of the most advanced electronic medical record systems around. Personally, at this point I’d say I’d rather have my records in the cloud than on an external hard-drive: I’m less afraid of hackers than of absent-minded staffers…

Women Who Doctor Part-Time: The Backlash, The Debate

On Sunday, The New York Times published a provocative op-ed arguing that women doctors who cut back to part-time are contributing to the national doctor shortage, and that they have an obligation to work full-time. Now for the backlash, and the debate.

On Monday, we published a powerful, data-driven riposte here, and WBUR’s “On Point” with Tom Ashbrook plans to devote its second hour to the topic tomorrow. Today, the Times carries a few more counter-punches in its letters column here.

Excerpts from my personal favorites:

Dr. Sibert claims that “medicine shouldn’t be a part-time interest, to be set aside if it becomes inconvenient.” I would argue that the same holds true for my child.

I chose to work as part-time doctor early in my career to be supportive to my full-time physician wife. Being asked about my parenting intentions at any point in the process would have been chilling.

And speaking of chilling, here’s a comment on our CommonHealth post:

I worked part time when my first child was born and found it to be incredibly unrewarding. I worked a lot of extra unpaid hours and yet when I was introduced (by a man) to the new head of the hospital, he said, “This is Dr. M., she has the cutest one year old you’ll ever see.” which really wasn’t how I defined my role in the hospital! There was no chance of career advancement and it just felt like a huge compromise. When my second child proved to be difficult to care for I happily quit that job and somehow never found a position that didn’t feel like another treading water situation. If one more person tells me to review cases for insurance companies, I’ll scream–I went to Med School to be able to help people solve problems in a therapeutic relationship, not to do scut work for the rest of my career!

And a post-script: Former Globe reporter Judy Dobrzynski points out on Facebook that Brits were making the same argument against part-time women doctors in 2008 — and in her view, it was “as unconvincing then as it is now.”