internal medicine

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Health Boost: Story-Sharing Kiosk For Hospital Patients Coping With Illness Set To Launch

If you were really sick, with cancer, let’s say, or a debilitating eating disorder or heart condition that put you in the hospital, would you want to hear from other patients like you? Would you feel better sharing your story? A growing body of research suggests you would.

That’s the idea behind the SharingClinic, a kiosk stocked with a collection of audio clips from patients facing a range of illnesses. It’s set to launch as an interactive exhibit at the Massachusetts General Hospital Paul S. Russell Museum in January. The goal is to ultimately move the listening kiosk into the main hospital.

The project was born out of frustration with a medical system that no longer has the time to really listen to patients, says Dr. Annie Brewster, an MGH internist who’s been developing the listening kiosk for the past four years. Brewster (a frequent contributor to CommonHealth) is also the founder of Health Story Collaborative, a non-profit that helps patients and caregivers tell their own medical stories for therapeutic value.

Patients visiting the SharingClinic can choose from a range of story types and perspectives. (Courtesy: Tara Keppler, graphic design)

Patients visiting the SharingClinic can choose from a range of story types and perspectives. (Courtesy: Tara Keppler, graphic design)

Ultimately, the MGH kiosk will offer a range of storytelling from different perspectives: hospital patients, their families and friends, doctors, nurses, psychiatrists and others. A touch screen allows listeners to select stories by diagnosis, by theme or by perspective. Listeners will also be able to comment. Currently over 100 clips are already collected, and the process is ongoing. The software, designed in collaboration with computer programmer David Nunez, previously at the MIT Media Lab, allows for easy, regular addition of new content. A downloadable app is currently in development.

“SharingClinic will take on a life of its own, constantly growing and changing, shaped by story sharers and listeners,” Brewster said. Listen to few sample clips:

Why did she embark on all this? Brewster says: “Facing illness can be scary and isolating, and hospitals an be alienating. Our goals are to empower and connect individuals facing health challenges — to remind people that they are not alone — and to improve the culture of the hospital through storytelling.”

Brewster herself is involved in the audio collection and editing process, but has also recruited other providers to help; her goal is to transform the culture of the hospital through storytelling. So far, she has an MGH chaplain and two MGH social workers helping with story collection. Eventually, she envisions having an actual story-sharing “clinic” at MGH — a dedicated physical site, open at a regularly scheduled time, where patients and providers can come to share their stories. She hopes to staff this “clinic” with other healthcare providers across disciplines — doctors, nurses, mental health professionals and chaplains. Story clips will then be plugged into the kiosk, where they can be shared with any visitor to the MGH museum, part of the MGH campus.

“It would, of course, be ideal to have time for such story sharing within medical visits, but I don’t see this happening at any time soon given the structure of the health care system today,” says Brewster. “Because of this, we need to create other opportunities to share, feel listened to and feel like we are contributing to a collective conversation about illness and healing.” Continue reading

Shameful Operating Room Moments: Medical Journal On Calling Out ‘Dirtball’ Doctors

(Just Us 3/Flickr)

An essay published in the Annals of Internal Medicine begs the question: How many of us are being mocked and crudely disrespected while we’re at our most vulnerable? (Just Us 3/Flickr)

Imagine this scene:

A female patient under general anesthesia is being prepped for a vaginal hysterectomy. As the attending doctor washes and scrubs her labia and inner thighs, he turns to a medical student and says: “I bet she’s enjoying this.” Then he winks and laughs.

No, this account doesn’t come from a racy British tabloid. It was published this week in a reputable medical journal, Annals of Internal Medicine.

The account, written by an anonymous doctor and titled “Our Family Secrets,” also describes an incident involving an obstetric patient, Mrs. Lopez, who experienced hemorrhaging and other complications after childbirth. To stop the bleeding and ultimately save the patient, her doctor performs what is called an “internal bimanual uterine massage,” which means he must get his entire hand inside her vagina. From the piece:

“…something happened that I’ll never forget. Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.’ He sings, ‘La Cucaracha, la cucaracha, dada, dada, dada-daaa.’ It looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head. All the while, he holds her, his whole hand still inside her vagina. He starts laughing. He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, assholes!’ And we stop.”

Stomach Churning

Dr. Christine Laine, editor in chief of Annals of Internal Medicine, said this is the first time in her tenure that such a profanity has been printed in the journal. But, she said in an interview, it seemed appropriate in this case. When she first read the essay she says it made her “stomach churn,” and it made her angry.

“Angry for the patients … angry for the younger physicians who encountered this behavior, angry at myself and others who have witnessed colleagues being disrespectful to patients but were too timid to speak out,” Laine said.

In an accompanying editorial condemning the behavior described in the essay, Laine and her colleagues wrote: “The first incident reeked of misogyny and disrespect — the second reeked of all that plus heavy overtones of sexual assault and racism.”

So how did this series of unfortunate medical events unfold?

Here’s the backstory: The anonymous author of the essay (the journal decided to keep the doctor’s identity a secret) was leading a course on medical humanities for senior medical students. The topic was “the virtue of forgiveness.” At one point the doctor put a question to the class: “Do any of you have someone to forgive from your clinical experiences? Did anything ever happen that you need to forgive or perhaps still can’t forgive?” Continue reading

Why The Primary Care Problem (Lower Status, Pay) Matters

By Jeff Levin-Scherz, M.D., M.B.A.
Guest Contributor

Medscape just published its annual physician compensation survey. The survey includes almost 20,000 physicians and is given online, so it’s probably not entirely representative.

Also, the survey results are self-reported, and physicians generally under-report their income. But the comparative reported income among specialties is informative. This survey is among the largest available, and does not require an expensive paid subscription.

(Courtesy of Medscape)

(Courtesy of Medscape)

The results are no surprise. But they’re worth noting: Specialists make 45 percent more than primary care physicians, and orthopedists make 224 percent more than pediatricians.

The majority of respondent physicians were employed, and men consistently make more than women in the same specialty. Women have the largest representation in specialties with the lowest incomes.

Physician income was a bit lower in the Northeast but higher in the Northwest. Massachusetts’ physicians report that their income is 46th in the nation.

Internists are the least satisfied in their job (47 percent), and the least likely to choose their specialty if they could choose again (25 percent), but high in the rankings of specialties where the respondent would choose medicine again (71 percent).

(Courtesy of Medscape)

(Courtesy of Medscape)

Family physicians were only slightly more likely to choose the same specialty again as internists (31 percent), yet they were the most likely to say they would choose to go into medicine again (74 percent).

Pediatrician income is among the lowest of all specialties, yet they are twice as likely to say that they would choose the same specialty. Internists and family physicians would go into medicine again, but they would go into sub-specialties, and not do general primary care. The high cost of health care in the U.S. is in part due not to a shortage of primary care physicians, but also due to a surplus of specialists.

Why does all this matter?

The American College of Physicians reported on the impending “collapse” of primary care in 2006. There have been efforts to change this situation since, including “patient centered medical homes,” and short-term enhanced Medicaid primary care fee schedules built into the Affordable Care Act.

The continued relatively lower pay of primary care physicians and the lack of job satisfaction of general internists and family physicians means that our historic way of delivering primary care is about to change. Much future primary care is likely to be delivered by nurse practitioners or physician assistants, and some office-based primary care will be supplanted by telehealth or by apps with underlying algorithms.

The Medscape survey suggests that we will continue to face serious challenges to continue to deliver the highly personalized primary care which many of us value, and the highly coordinated care needed by the frail elderly and those with serious chronic illnesses.

Continue reading

Got A Headache? Study Finds Flaws In Treatment, ‘Alarming’ Rise In Imaging Tests

(19melissa68/Flickr)

(19melissa68/Flickr)

Sometimes less really is more. A case in point: the treatment of routine headaches.

Doctors are increasingly ordering pricey, advanced imaging tests and referring patients to specialists, which, it turns out, offers little help to headache sufferers, a new study concludes.

Researchers from Boston’s Beth Israel Deaconess Medical Center suggest that patients might be better served (and the health care system might save money) by instead focusing more on lifestyle changes for people seeking headache relief.

For the study, published online in the Journal of General Internal Medicine, researchers used a nationally representative database to analyze practice patterns among physicians treating headache patients.

I asked the lead author, John N. Mafi, MD, a fellow in the Division of General Medicine and Primary Care at BIDMC, to sum up the bottom line results. Here (slightly edited) is his emailed response:

“…We found alarming rises in use of advanced imaging (CT/MRI), referrals to other physicians (presumably specialists), and a decline in first-line recommended life-style modification counseling, meant to prevent headaches. We also saw no change in use of discouraged medications, with opioids and barbiturates ordered in about 18% of visits throughout the study period.

These findings represent alarming trends in the management of headache, and to me, they reflect a larger trend in the U.S. healthcare system where over-hurried doctors are ordering more tests, more medications, more referrals to specialists and less time talking and connecting with their patients.

To me this suggests that the visit-based model of healthcare is broken, Continue reading