This month, AMA Journal of Ethics theme editor Natasha Dolgin, an MD/PhD candidate at the University of Massachusetts School of Medicine, interviewed Dorry Segev, MD, PhD, about organ allocation policy and geographic disparities in access, possible ways to maximize equity, and advice physicians should give their patients between policy changes. Dr. Segev is an associate professor of surgery at Johns Hopkins University School of Medicine.
This month, AMA Journal of Ethics theme editor Trisha Paul, a second-year medical student at the University of Michigan Medical School, interviewed Kelly Parent about what makes patient- and family-centered care an inclusive approach to health care delivery and how this approach is being implemented. Kelly Parent is the patient- and family-centered care program specialist for quality and safety at the University of Michigan Health System.
This month, AMA Journal of Ethics theme editor Cynthia Tsay, MPhil, a second-year medical student at the Yale School of Medicine, interviewed Robert Levine, MD, about changes in clinical research guidelines, problems with IRB documentation, and the top ethical challenges facing clinical researchers today. Dr. Levine is a professor of medicine at the Yale School of Medicine and a Hastings Center fellow.
This month, AMA Journal of Ethics editor-in-chief Audiey Kao, MD, PhD, interviewed Wendy Levinson, MD, about the efforts of the Choosing Wisely initiative to foster cultural change in medicine cross-nationally by stimulating dialogue about overuse of tests and treatments. Dr. Levinson is professor of medicine at the University of Toronto and leads Choosing Wisely Canada and International.
This month, AMA Journal of Ethics theme editor Nikhil A. Patel, MS, a fourth-year medical student at the Mayo Medical School, interviewed Joia Mukherjee, MD, MPH, about Partners In Health’s mission to strengthen low-income countries’ health care systems and lessons learned from the Ebola crisis. Dr. Mukherjee is the chief medical officer of Partners In Health and an associate professor at Harvard Medical School and Brigham and Women’s Hospital.
This month, AMA Journal of Ethics theme editor W. Miller Johnstone III, MD, PhD, a resident in obstetrics and gynecology at the University of Buffalo, interviewed Kate M. Lally, MD, about patient-centered management of end-of-life care, the unique care needs of women with advanced gynecologic cancers, and how to prepare medical students and residents to hold difficult conversations with patients. Dr. Lally is the director of palliative care for Care New England Health System and a clinical assistant professor of medicine at the Warren Alpert Medical School of Brown University.
This month, AMA Journal of Ethics editor-in-chief Audiey Kao, MD, PhD, interviewed Peter A. Ubel, MD, about factors contributing to the high cost of health care, how to bend the cost curve, and the compatibility of cost containment and profit seeking. Dr. Ubel is the Dennis T. McLawhorn University Professor at the Duke University Fuqua School of Business.
AMA Journal of Ethics theme editor Amanda Xi, MD, a transitional year resident at Henry Ford Hospital, interviewed Donald M. Berwick, MD, shortly before the Supreme Court’s decision in King versus Burwell. Dr. Berwick discussed progress in meeting the health care goals of the ACA and the Institute for Healthcare Improvement and next steps for improving patient care. A former head of the Centers for Medicare and Medicaid Services, Dr. Berwick is a senior fellow and president emeritus at the Institute for Healthcare Improvement.
This month, AMA Journal of Ethics theme editor, Gaurav Jay Dhiman, a third-year medical student at the University of Miami Leonard M. Miller School of Medicine, interviewed Jonathan D. Moreno, PhD, on the role of bioethicists in military research and ethical issues in research on people with disabilities. Dr. Moreno is the David and Lyn Silfen University Professor of Ethics at the University of Pennsylvania.
This month, AMA Journal of Ethics theme editor, Nadi N. Kaonga, a medical student and predoctoral candidate at Tufts University in Boston, interviewed Gordon D. Schiff, MD, on reframing professional boundaries in the patient-physician relationship. Dr. Schiff, author of "Crossing Boundaries—Violation or Obligation?," is a primary care physician and activist and a safety and quality improvement researcher at Harvard University and Brigham and Women’s Hospital.
AMA Journal of Ethics editor Audiey Kao, MD, PhD, interviewed Kenneth Sands, MD, about harms to patient dignity caused by unintentional disrespect and about initiatives for measuring, tracking, and correcting such harms. Dr. Sands is chief quality officer at Beth Israel Deaconess Medical Center in Boston.
This month, AMA Journal of Ethics theme editor Kathleen K. Miller, MD, a first-year resident in pediatrics at the University of Wisconsin-Madison, interviewed Deborah R. Barnbaum, PhD, on the theory of mind and its implications for treatment of people with autism. Dr. Barnbaum is chair of the Department of Philosophy at Kent State University and coordinator of the department’s Health Care Ethics program.
This month, AMA Journal of Ethics theme editor Matthew Edwards, a third-year medical student at the University of Texas Medical Branch School of Medicine, interviewed Douglas R. Bacon, MD, MA, on the development of anesthesiology and the “balanced anesthesia” approach. Dr. Bacon is chairman of the Department of Anesthesiology at the University of Mississippi Medical Center.
AMA Journal of Ethics editor Audiey Kao, MD, PhD, interviewed Richard Pan, MD, MPH, about how, as a physician and legislator, he seeks to protect public health in light of recurrent outbreaks of vaccine-preventable infectious diseases. Dr. Pan is a pediatrician and California state senator who has contributed to community development and increasing oversight of government health programs.
This month, AMA Journal of Ethics theme editor Marta Michalska-Smith, a second-year medical student at the Loyola University Chicago Stritch School of Medicine, interviewed Linda Brubaker, MD, MS, and Marc G. Kuczewski, PhD, about Stritch’s admissions policy welcoming applications from students of DACA status and the challenges and promise of implementing this strategy. Dr. Brubaker is dean of the Stritch School of Medicine and Dr. Kuczewski is director of the Neiswanger Institute for Bioethics and Health Policy and chair of the Department of Medical Education at the Stritch School of Medicine.
This month, Virtual Mentor theme editor Jordan P. Amadio, MD, MBA, a senior neurosurgery resident at Emory University School of Medicine in Atlanta, Georgia, interviewed Paul Root Wolpe, PhD, about the ethical import of new technologies and the practical import of the White House Brain Initiative for neurosurgeons and neurosurgeons in training. Dr. Wolpe is the Asa Griggs Candler Professor of Bioethics and the director of the Center for Bioethics at Emory University and serves as editor-in-chief of the American Journal of Bioethics: Neuroscience.
This month, Virtual Mentor theme editor Vinod Nambudiri, MD, MBA, a resident in internal medicine and dermatology in the Harvard Combined Medicine-Dermatology Residency Training Program, interviewed Naomi Fried, PhD, about telemedicine's regulatory challenges and the opportunities it presents for innovation in health care delivery and medical education. Dr. Fried is chief innovation officer at Boston Children's Hospital and a board member of the American Telemedicine Association.
This month, Virtual Mentor interviewed Drew Pinsky, MD, assistant professor of psychiatry at the Keck School of Medicine of the University of Southern California and media personality who has been talking to and educating the public about love, sex, and relationships for more than 25 years. We spoke with him about how he got his start in media, the sex addiction diagnosis, and the ethical challenges that come with providing health care information over the airwaves.
This month, Virtual Mentor issue editor Rashmi Kudesia interviewed Sarah S. Richardson about the emerging field of "maternal effects," that is, the study of the influences of a pregnant woman's behavior, exposures, and physiology on her offspring's future health and development. Dr. Richardson is associate professor of the history of science and of studies of women, gender, and sexuality at Harvard University. Rashmi Kudesia, MD, is a fellow in reproductive endocrinology and infertility at Albert Einstein College of Medicine in New York City.
In the September 2014 issue on physicians as agents of social change, Dr. Audiey Kao, editor-in-chief of Virtual Mentor interviewed Dr. Rajiv Shah, administrator of the United States Agency for International Development or USAID. We spoke about the mission of USAID and how being a physician informs his role as the administrator.
This month theme issue editor, Trahern Jones, a fourth-year student at Mayo Medical School in Rochester, Minnesota, spoke with Dr. Edward Laskowski about the use of performance-enhancing drugs and substances among athletes today. Dr. Laskowski is a professor of physical medicine and rehabilitation and co-director of the Mayo Clinic Sports Medicine Center. He has also served as physician for the US Winter Olympics team and as consultant to the National Hockey League Players Association.
This month theme issue editor Mariam Fofana, an MD-PhD student at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, interviewed Dr. Thomas Duffy, professor of hematology and director of the Program for Humanities in Medicine at Yale School of Medicine in New Haven, Connecticut. She asked him to reflect on his time as a medical student and resident at Johns Hopkins during the 1960s.
This month, Virtual Mentor theme issue editor Kimberley Swartz, a medical student at the University of Florida College of Medicine, interviewed Dr. Gary Wang about the use of Truvada, approved in 2012 as a pre-exposure prophylaxis against HIV infection. Dr. Wang is an assistant professor of medicine in the Division of Infectious Diseases and Global Medicine at the University of Florida College of Medicine.
This month, theme issue editor Ajay Major, a medical student at Albany Medical College, interviewed Dr. Pauline Chen about the problem of bullying in medical education. Dr. Chen, a surgeon specializing in liver and kidney transplants and the treatment of cancer, writes the New York Times online column "Doctor and Patient" and is author of the national bestseller, Final Exam: A Surgeon's Reflections on Mortality.
This month Virtual Mentor theme issue editor Elizabeth Miranda, a medical student at the Keck School of Medicine of the University of Southern California in Los Angeles, interviewed Dr. Elliott Fisher about the problem of unwarranted variation in health care services. Dr. Fisher is director of the Dartmouth Institute for Health Policy and Clinical Practice and is professor of medicine at the Dartmouth Institute and the Geisel School of Medicine at Dartmouth University.
This month, Virtual Mentor theme issue editor, Katie Falloon, a medical student at the Duke University School of Medicine, interviewed Dr. Thomas Price about the ethical and regulatory issues associated with assisted reproductive technologies (ART). Dr. Price is associate professor of obstetrics and gynecology and interim chief of reproductive endocrinology and fertility at the Duke University School of Medicine in Durham, North Carolina.
Virtual Mentor issue editor Sophia Cedola, a medical student at Columbia University College of Physicians and Surgeons, interviewed Dr. Craig Blinderman about talking with patients who are terminally ill, asking him whether there are some key "do's" and "don'ts" for having end-of-life conversations with patients and their families. Dr. Blinderman is the Director of the Adult Palliative Medicine Service and Co-Director of the Center for Supportive Care and Clinical Ethics in the Department of Medicine at Columbia University Medical Center in New York.
This month, Colleen Farrell, a second-year medical student at Harvard Medical School, interviewed Dr. Sad Sayeed, assistant professor of Global Health and Social Medicine at Harvard Medical School and attending neonatologist and assistant professor of pediatrics at Children's Hospital Boston. In the interview Dr. Sayeed discusses the distinctive challenges of becoming a new mother. He also shares his insights on caring for terminally ill children and helping mothers and fathers come to terms with the unimaginable fact that their child is dying.
This month, Mark Kissler, a medical student at Baylor College of Medicine, interviewed Dr. Ronald DePinho, President of the University of Texas MD Anderson Cancer Center. In the interview Dr. DePinho discusses exciting research discoveries in cancer prevention and treatment and explains why a multidisciplinary approach to patient care is the best way to improve individuals' lives now and in the future.
This month Virtual Mentor theme issue editor, Jennifer Chevinsky, from the University of South Florida Morsani College of Medicine, interviewed Dr. Stephen Klasko, CEO of University of South Florida Health, Dean of University of South Florida Morsani College of Medicine, and founder and director of the Stephen K. Klasko Institute for an Optimistic Future in Health Care. In the interview, Dr. Klasko discusses why team-based care is a key component in the future of health care and why medical students and residents should be taught in medical school how to practice as team members with their medical colleagues and staff.
In February 2012 The New York Times featured an article on a 60-person chain of kidney transplants that resulted in 30 individuals receiving donated kidneys. The article highlighted the growing demand for donated kidneys and the unique challenges of kidney transplantation. This month, Virtual Mentor's theme issue editor for March 2012, Alon Neidich, interviewed Dr. Al Roth about the growing importance of paired kidney exchanges for incompatible patient-donor pairs. Dr. Roth is the George Gund Professor of Economics and Business Administration in Department of Economics at Harvard University, and in the Harvard Business School, and is one of the founders and designers of the New England Program for Kidney Exchange.
Often, when we visit our doctor, we simply want to know, "What is it? What is the name of the ailment that is causing me to feel this way? Do my symptoms add up to something that can be recognized with a single label? And what will that label mean?" Very often, the diagnosis we get affects the course of our lives. This month, Virtual Mentor spoke with Dr. Catherine Belling, associate professor of medical humanities and bioethics at Northwestern University Feinberg School of Medicine, about the power of diagnosis and how it can change the way we view ourselves, others, and the world around us.
Since the 2008 election, health care reform has been one of the key issues dominating political and civil discourse throughout the country. Recently the debates around health reform have only intensified as looming cuts threaten to reduce physician Medicare by nearly 30%. This month, Virtual Mentor spoke with Dr. Peter W. Carmel, President of the American Medical Association (AMA), to discuss health reform and, specifically, why the AMA supports the full repeal of the formula used to calculate Medicare payments to physicians.
We hear a lot about health care reform from the perspective of physicians who are already members of the medical establishment—whether they are for health care reform, or against it. But what about new and future doctors who will enter medicine during this dynamic period of change and restructuring? This month Virtual Mentor spoke with Dr. Alex Ding, a resident physician in the department of radiology at Massachusetts General Hospital, and Mr. Jordan VanLare, a fourth-year medical student at Columbia University College of Physicians and Surgeons, about their impressions of health reform and how it will impact the medical practice environment they will soon enter.
Some say little has improved in the 12 years since the Institute of Medicine drew the nation's attention to the unacceptable number of "adverse unexpected events—read "errors"—in U.S. hospitals.Virtual Mentor spoke with Dr. David Classen, associate professor of medicine at the University of Utah, about the current state of patient safety in the United States. Dr Classen discussed the goals and challenges of improving patient safety in inpatient and ambulatory settings and how health care reform will impact future efforts to improve patient safety.
One initiative in the system wide, concerted effort to bring medical errors under control has been the development of patient safety training and educational programs for nurses, physicians, and other health professionals. Virtual Mentor spoke with Patricia Sokol, RN, JD, senior policy analyst at the American Medical Association, about the growing number of institutions that offer graduate training for health professionals in patient safety science and how these programs are critical to establishing a safer overall health care system
According to the American Telemedicine Association, "Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status." The promise of telemedicine is that it will improve the delivery and efficiency of health care services. Virtual Mentor spoke with Dr. Emeka Okafor, assistant professor of emergency medicine at the University of Texas Medical School at Houston, about the benefits of, and barriers to, use of telemedicine, and what can be done to help regulate this growing industry.
In advance directives, we tell our physicians and surrogate decision makers what types of care we want—and don't want—when we can no longer make decisions for ourselves. But research consistently shows a gap between patients' preferences for end-of-life care and what their surrogate decision makers think those patients want. Neuroscience and, more specifically, a specific form brain imaging—fMRI—may be able to help close that gap. By imaging a person's brain while he or she is making a decision, researchers can tell which part of the brain is being brought to the specific decision-making task. Such findings have shown that the part of the brain that becomes active when a research subject is making decisions based on purely personal preference is different from the part that becomes active when the subject is making socially or morally guided decisions. Instructing a surrogate to make one's end-of-life decisions should be a social, morally guided decision, not a purely personal one. So perhaps posing end-of-life care questions in a social, moral frame rather than a purely personal frame will elicit care decisions from patients that align more closely with decisions their surrogates would make.
The Military Personnel Eligibility Act of 1993, commonly known as "Don't Ask, Don't Tell," allowed gays to serve in the U.S. military as long as they did not make their sexual orientation known. The act has long been a hot-button issue for many politicians, gay rights activists, conservative pundits, and members of the armed forces. The debate has become more heated in the last year as President Obama and Democratic Party leaders made clear they wanted Congress to repeal the act. In May 2010, the House of Representatives and the Senate's Armed Services Committee voted to repeal the measure, contingent upon a Department of Defense survey of military personnel about the anticipated effects of the repeal. Virtual Mentor spoke with Dr. Saul Levin, vice president of science, medicine, and public health at the American Medical Association about the effect of Don't Ask, Don't Tell on physicians and why the AMA supports of repeal of the controversial Act.
Over the past decade there have been numerous stories about overcrowded ERs. One way many communities addressed such overcrowding was to divert ambulances away from overcrowded hospitals to less busy ones that had available room and resources to treat patients. In Jan 2009, Massachusetts became first state to successfully ban the practice of ambulance diversion. Virtual Mentor spoke with Dr. Stephen Epstein of Harvard Medical School about the Massachusetts ban and what other communities can learn from one state's experience.
Cosmetic surgery is a hotly debated issue in our society. Is it a consumer good or a medical procedure? Should elective procedures be taxed? Does plastic surgery promote oppressive norms of beauty? Virtual Mentor asked six "people on the street" in Chicago for their views about the personal and social effects of elective cosmetic surgery.
Despite the fact that the majority of Americans are now medically defined as overweight, stigma against individuals who are obese remains a widespread phenomenon. Virtual Mentor asked Dr. Rebecca Puhl, Director of Research and Anti-Stigma Initiatives at the Rudd Center for Food Policy and Obesity at Yale University to comment on the prevalence in our society and in health care and what can be to help ameliorate it.
Some physicians believe that knowing about patients' religious and spiritual beliefs helps them care for the whole person. There is even evidence that patients who are part of faith traditions and attend services regularly are healthier. Other physicians believe medicine and religion should be kept separate, and encourage their patients to talk to a chaplain for spiritual support in times of suffering. This interview with a physician-theologian, medical student, and patient explores a range of perspectives on what has become a hotly debated topic.
For somewhere between $200 and $2,000, curious individuals can sign up with an Internet service, send in a drop of saliva or some cheek cells and receive a report on their ancestry and their predisposition to a number of medical conditions from type 2 diabetes to baldness or back pain. "Ethics Talk" interviewed two people who used the online service for very different reasons.
Fewer medical students are selecting primary care specialties such as family medicine and pediatrics, a trend which could cause a shortage in the types of physicians society needs most. Two medical students explain the reasons for their choices of specialty and comment on possible reasons for the trend.
Today's patients are better informed about possible causes and treatments for their symptoms than ever before. A physician works through a challenging encounter with a patient who comes to her office demanding a particular brand name drug and will accept nothing less--or so it seems at first.
Graduating medical students still report being belittled and mistreated by their instructors and clinical faculty. Two medical students and a resident physician discuss this phenomenon and the procedures that all accredited medical schools have in place for responding to student reports of mistreatment.
More and more employer-based insurance plans are using incentives and penalties to encourage healthy lifestyle choices among those they insure. Sometimes these wellness programs employ "carrots" and "sticks" that limit benefits or charge more for coverage. A company benefits representative, health insurance executive, and a physician discuss the new trend in wellness programs and how they affect patients, the patient-physician relationship, and employers.
The viewpoints expressed on these podcasts are those of the interviewees and do not necessarily reflect the views and policies of the AMA.