Category: Opinion

Categories
Clinical Community Service Emotion Empathy General Healthcare Disparities Opinion Public Health

Let Me Be Brief: Community Leadership

A series of briefs by Texas Medical Students

By: Fareen Momin, Sereena Jivraj, and Melissa Huddleston

In the ever-evolving field of medicine, it is no surprise that the idea of leadership in medicine has changed over the years. Some physicians have engaged in additional leadership in the context of politics. In fact, several physicians signed the Declaration of Independence.1 Today, physician community leadership extends much further. Physicians can engage with their communities and beyond via virtual platforms. Physician “influencers” use social media to provide quick answers to patients, and physician-patient interactions on Twitter alone have increased 93% since the onset of the COVID-19 pandemic.2 With physician voices reaching ever-larger audiences, we must consider the benefits and ramifications of expanding our roles as community leaders.

Medicine and politics, once considered incompatible, are now connected.3 There is a long list of physician-politicians, and community members often encourage physicians to run for political office, as in the case of surgeon and former representative Tom Price.4 Physicians are distinctly equipped to provide insight and serve as advocates for their communities.5 Seeking to leverage this position, a political action committee (PAC), Doctors in Politics, has an ambitious desire to send 50 physicians to Congress in 2022, so they can advocate for security of coverage and freedom for patients to choose their doctor.6-7 There are dangers, however, when physicians take on this additional leadership role. For example, Senator Rand Paul (R-Ky.), an ophthalmologist, has spread medical misinformation, telling those who have had COVID-19 to “throw away their masks, go to restaurants, and live again because these people are now immune.”8

It is not practical for even those medical students who meet age requirements to run for office. What we can do is use our collective voice to hold our leaders accountable, especially when they represent our profession. We can create petitions to censure physicians who have caused harm and can serve as whistleblowers when we find evidence of wrong-doing perpetrated by healthcare professionals. We can also start engaging in patient advocacy and policy-shaping with the American Medical Association (AMA) Medical Student Section and professional organizations related to our specialty interest(s).

To avoid adding to confusion, statements by physicians should always be grounded in evidence. Dr. Fauci’s leadership is exemplary in this regard. He has worked alongside seven presidents, led the National Institute of Allergy and Infectious Diseases (NIAID) since 1984, and has become a well-known figure due to his role in guiding the nation with evidence-based research concerning the COVID-19 pandemic.9 Similarly, Dr. John Whyte, CMO for WebMD, has collaborated with the Food and Drug Administration (FDA) to advocate for safe use of medication and to educate those with vaccine apprehension.10 Following these examples, we should strive to collaborate with public health leaders and other healthcare practitioners and to advance health, wellness, and social outcomes and, in this way, have a lasting impact as leaders in the community.

  1. Goldstein Strong Medicine: Doctors Who Signed the Declaration of Independence. Cunningham Group. Published July 7, 2008. Accessed February 2, 2021. https://www.cunninghamgroupins.com/strong-medicine-doctors-who-signed-the-declaration-of-independence/
  2. Patient Engagement with Physicians on Twitter Doubles During BusinessWire. Published December 17, 2020. Accessed February 2, 2021. https://www.businesswire.com/news/home/20201217005306/en/Patient-Engagement-with-Physicians-on-Twitter- Doubles-During-Pandemic
  3. WHALEN THE DOCTOR AS A POLITICIAN. JAMA. 1899;XXXII(14):756–759. doi:10.1001/jama.1899.92450410016002d
  4. Stanley From Physician to Legislator: The Long History of Doctors in Politics. The Rotation. Published May 15, Accessed February 2, 2021. https://the-rotation.com/from-physician-to-legislator-the-long-history-of-doctors-in-politics/
  5. Carsen S, Xia The physician as leader. Mcgill J Med. 2006;9(1):1-2.
  6. Doctors in Politics Launches Ambitious Effort to Send 50 Physicians to Congress In 2022. BusinessWire. Published May 27, 2020. Accessed February 2, 2021. https://www.businesswire.com/news/home/20200527005230/en/Doctors-in-Politics-Launches-Ambitious-Effort-to- Send-50-Physicians-to-Congress-In-2022
  7. Doctors in Accessed February 2, 2021. https://doctorsinpolitics.org/whoweare
  8. Gstalter Rand Paul says COVID-19 survivors should “throw away their masks, go to restaurants, live again.” TheHill. Published November 13, 2020. Accessed February 2, 2021. https://thehill.com/homenews/senate/525819-rand-paul-says-covid-19-survivors-should-throw-away-their-masks-go-to
  9. Anthony Fauci, M.D. | NIH: National Institute of Allergy and Infectious Diseases. Published January 20, 2021. Accessed February 2, 2021. https://www.niaid.nih.gov/about/anthony-s-fauci-md-bio
  10. Parks Physicians in government: The FDA and public health. American Medical Association. Published June 29, 2016. Accessed February 2, 2021. https://www.ama-assn.org/residents-students/transition-practice/physicians-government-fda-and-public-health
Categories
Clinical Emotion Empathy General Humanistic Psychology Opinion

Let Me Be Brief: A Proposal to Refrain From Eating Our Young

A series of briefs by the Texas Medical Students

By: Elleana Majdinasab and Rishi Gonuguntla

Medicine has its unspoken mores, does it not? Certain specialties are notorious for their personalities, and the idea of foregoing food and sleep are deemed signs of strength and resilience. Upperclassmen advise against getting in Dr. X’s way, lest you become subject to a tailored diatribe, and you hear whispers of Dr. Y’s career-crushing evaluations. Your roommates do not bat an eye over your tears every  evening, because chances are they are no stranger to such days themselves. It doesn’t require a detective to identify that the above are the direct result of mistreatment in medical school.

Per the AAMC, mistreatment occurs when there is a show of disrespect for another person that unreasonably affects the learning process. Public humiliation and belittlement by doctors are the most common forms of mistreatment in medical school.1 The practice of aggressive “pimping,” or the act of doctors disparaging students for not knowing information, potentially in front of patients or fellow classmates, is a phenomenon too many medical students needlessly experience.2 Other examples of mistreatment include the shaming of students for asking questions and being subjected to offensive names and remarks.1 According to one 2014 study, over three-fourths of third year medical students reported being mistreated by residents, with over 10% of those responses citing recurrent mistreatment.2

Given the omnipresence of these events, one may consider whether there exists a common denominator among guilty attending physicians. Indeed, mistreatment of medical students can  occur secondary to a multitude of reasons. Physician burnout is still rampant as ever, and ironically, often occurs partly due to the same toxic culture attendings themselves experienced as budding residents.3 The doctors in question blissfully perpetuate the cycle, humiliating and pimping, justifying  their behavior with the mentality of, “I went through it back then and turned out just fine.” Thus, the vicious cycle continues. What doesn’t kill you makes you stronger, right?

As medical students, we are quietly told by the older and wiser to improve our resilience – to grow tougher skin. We are advised to expect, or even welcome, microaggressions and impatience from our superiors while we work toward our lifelong dreams.4 We take deep breaths and smile through the jabs because we are fully aware of the consequences of speaking out against the deeply ingrained practice of mistreatment.4 Mistreatment in medical school matters because doctors eating their young further propagates the toxic reputation of the career’s culture while contributing to the development of many future doctors’ unhappiness.3 It is the accumulation of years of pressure, competition, and negative experiences that leads to feelings of burnout in students and physicians alike.5 Even worse, medical students act on these feelings, and they are three times more likely to commit suicide than their similar-aged peers in other educational settings in the general population.6 The hazing of medical students is in no way constructive or beneficial to anybody involved. Stress and toxicity in the learning environment prevents students from being themselves and asking questions, thus damaging their confidence during the formative years of their training.7

Even more alarming is that mistreatment is more commonly directed towards minority students, including female, underrepresented in medicine, Asian, multiracial, and LGBTQ+ students, than it is toward their white, cis-gendered, heterosexual, male counterparts.8 In the same vein that we encourage and recruit people   from minority communities to join medicine, we must be aware of the potential mistreatment they will experience and take clear, targeted steps to protect them. If we, as a community, fail at this task, then we are complicit in perpetuating the systemic inequities and inequalities that are currently prevalent in medicine.

The reality is that the culture of medicine doesn’t have to be this way. It is certain that mistreatment has been inadvertently ingrained within the culture of medical training, so attempting to address this problem feels daunting. There is a current lack of literature regarding what interventions successfully reduce mistreatment, but introspective analysis yields some steps we may take in an attempt to slowly chip away at the current social infrastructure.9

First and foremost, students must realize and acknowledge the negativity they have been subjected to is not ‘all in their head,’ but instead a universal and rather unfounded experience. The next step is to seek support from classmates, friendly administration, and trusted professors and physicians who can provide guidance and vouch for students’ justice. Addressing mistreatment is at its core a collaborative effort, as we cannot expect only the bravest, most outspoken students to carry this initiative to fruition. Each and every person in medicine can enjoy a role and responsibility in this endeavor. School administrations can create interventions aimed at educating faculty and students about recognizing mistreatment and the harmful effects that public humiliation can have on student learning.10 It is only when students recognize abuse and have a strong support system that they may finally gain the confidence required to be vocal against toxic behavior and speak out for both themselves and classmates. Schools can further assist efforts by ensuring students are aware of their rights in this context, and offering guaranteed protection if mistreatment does rear its head.11 Current physicians may also positively contribute by gently and constructively pointing out questionable behavior among their colleagues to create a more effective learning environment. Finally, our generation of medical students is tenacious, progressive, and outspoken. We can weaken, and even break the cycle, by remembering our roots, exercising our rights, and manifesting the golden rule: to always treat others the way you want to be treated.

  1. 2020 GQ All Schools pdf. (n.d.).
  2. Cook, F., Arora, V. M., Rasinski, K. A., Curlin, F. A., & Yoon, J. D. (2014). The Prevalence of Medical Student Mistreatment and Its Association with Burnout. Academic Medicine : Journal of the Association of American Medical Colleges, 89(5), 749–754. https://doi.org/10.1097/ACM.0000000000000204
  3. Major, (2014). To Bully and Be Bullied: Harassment and Mistreatment in Medical Education. AMA Journal of Ethics, 16(3), 155–160. https://doi.org/10.1001/virtualmentor.2014.16.3.fred1-1403
  4. Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation | Medical Education and Training | JAMA Internal Medicine | JAMA Network. (n.d.). Retrieved March 16, 2021, from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2761274?guestAccessKe y=5b371de5-4978-4643-b125-f26972348616&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=022420
  5. Dyrbye, N., Thomas, M. R., Massie, F. S., Power, D. V., Eacker, A., Harper, W., Durning, S., Moutier, C., Szydlo, D. W., Novotny, P. J., Sloan, J. A., & Shanafelt, T. D. (2008). Burnout and suicidal ideation among U.S. medical students. Annals of Internal Medicine, 149(5), 334–341. https://doi.org/10.7326/0003-4819-149-5-200809020-00008
  6. Markman, D., Soeprono, T. M., Combs, H. L., & Cosgrove, E. M. (2019). Medical student mistreatment: Understanding ‘public humiliation.’ Medical Education Online, 24(1), 1615367. https://doi.org/10.1080/10872981.2019.1615367
  7. Full article: Exploring medical students’ barriers to reporting mistreatment during clerkships: A qualitative study. (n.d.). Retrieved March 16, 2021, from https://www.tandfonline.com/doi/full/10.1080/10872981.2018.1478170
  8. Hasty, N., Br, M. E., ford, Lau, M. J. N., MD, & MHPE. (n.d.). It’s Time to Address Student Mistreatment. American College of Surgeons. Retrieved March 16, 2021, from https://www.facs.org/Education/Division-of-Education/Publications/RISE/articles/student- mistreatment
  9. Markman, D., Soeprono, T. M., Combs, H. L., & Cosgrove, E. M. (2019). Medical student mistreatment: Understanding ‘public humiliation.’ Medical Education Online, 24(1), 1615367. https://doi.org/10.1080/10872981.2019.1615367
  10. Stone, J. P., Charette, J. H., McPhalen, D. F., & Temple-Oberle, C. (2015). Under the Knife: Medical Student Perceptions of Intimidation and Journal of Surgical Education, 72(4), 749–753. https://doi.org/10.1016/j.jsurg.2015.02.003
  11. Mazer, M., Bereknyei Merrell, S., Hasty, B. N., Stave, C., & Lau, J. N. (2018). Assessment of Programs Aimed to Decrease or Prevent Mistreatment of Medical Trainees. JAMA Network Open, 1(3), e180870–e180870. https://doi.org/10.1001/jamanetworkopen.2018.0870

 

Categories
Empathy General Medical Humanities Opinion Reflection

Visual Arts as a Window to Diagnosis and Care

With the rapid advancement of knowledge and technology in medicine, physicians alienate themselves from the core purpose of their profession. A grounding in the humanities as well as a strong foundational basis understanding the medical sciences is required to establish well-rounded physicians. Art inspires medical students and physicians to observe detail they otherwise wouldn’t. With patients in the emergency room, before any physician-patient interaction can occur, the sounds of bilateral crackles, the sight of neck muscles contracting and of the nostrils flaring indicate a patient in respiratory distress. This very detail in observation is needed for split-second decisions of utmost importance in the emergency theatre.

Art is the projection of our experiences, memories and has the power to record reality and fantasy. These altogether add to the artistic memory of an artist and allow them to add adaptations based on their life’s observations. Artists have captured the human body through the pursuit of conveying human experience, of the human’s appearances, shapes, and sounds all reflecting their state of health. Artists must see the details of a picture and reproduce it, and only once they’ve mastered observational art can they move on to more abstract forms conveying emotions of the real world.

When dissections were forbidden centuries ago, artists together with doctors snuck out to examine human corpses for a closer look. This was important for them to accurately reproduce representations as they not only had to know the inner workings of the human body just as physicians did but they needed the eye for their artistic creation. Unfortunately, today the acquisition of life-drawing skills has lost its traditional importance due to increased demands for the more conceptual art forms.

In medicine, observational skills provide insight into a patient’s problem.  From observing, not only do we see it as is but we recognize patterns, are able to analyze context and make connections. Despite knowing everything about a disease or illness, learning how to see pathologies, and diagnostic criteria is important to avoid missing all the signs. The four steps of physical examination are inspection, percussion, auscultation and palpation. Inspection or observation is often overlooked but is so crucial to patient care and treatment as is to the creation of art.

The artwork of Piero di Cosimo, A Satyr Mourning over a Nymph (1495) depicts a young woman killed accidentally during a deer hunt by a spear. Upon analysis of the painting and deep observation, evident is that there is no spear wound but instead the women’s arms are covered with long cuts as if acting in self defense from her assailant. Her left hand additionally is placed in position with her wrist flexed and fingers curling inwards known as “waiter’s tip”. Fundamentally at large, di Cosimo used the girl’s corpse as a model and because as an artist he had no understanding of medicine and injury, he portrayed exactly what he saw. Unintentionally, he captured the girl’s true injuries dictating to a medical practitioner the likely theory of the young woman’s actual cause of death.

A Satyr mourning over a Nymph by Piero di Cosimo
https://www.nationalgallery.org.uk/paintings/piero-di-cosimo-a-satyr-mourning-over-a-nymph

Appreciation for paintings by physicians even reveal medical diagnoses given the structural facial characteristic changes that occur in different diseases. The Old Woman by Quinten Massys depicted an exaggerated ugliness due to the pattern of facial deformations; bossing forehead, prominent cheekbones, enlarged maxilla and increased distance between the mouth and nose all consistent with leonine faces of Paget’s disease stemming from accelerated bone remodeling. Another example is that of Peter Paul Rubens, The Three Graces, displaying symptoms of benign hyper-mobility syndrome, an autosomal dominant disease. Scoliosis of the spine, a positive Trendelenburg sign and double jointedness as well as lax upper eyelids is evident in the artists painting.

Fascinating nonetheless is that the medical diagnoses in both paintings were unknown to doctors at that time. Paget’s Disease and benign hyper-mobility syndrome were discovered just a couple years ago while these paintings existed long before them. 

Compared to artists however, doctors have stopped putting their skill of inspection into practice and with all the expensive tests available to help doctors make diagnoses, the necessity of individual, physician observation has decreased. Thus raises a question, will the dependence on tests rather than investigation through the senses define the future of medicine?

As medical students, this urges us to hold true to the art of observation. Technological advances were directed to improve patient care and not impede the physician-patient relationship. The personal touch of a doctor and the direct communication through movement, and language has been lost. Remembering the feelings of our patients allows us as future physicians to be mindful that no patient manifests the same way despite presenting with the same disease. Neither are patients aware of the manifestations of disease and overtime naturally adapt to the abnormal posture, gait, and lifestyle changes often overlooking the skin changes, mood or weight fluctuations.

When doctors are trained to “see”, observe and infer from signs alone a basic diagnosis, will they understand the whole human being. Therefore, arts education in medicine helps humanize science and connect medical theory into the patient’s journey. In analyzing art pieces, students are able to connect clinical skills and improve their ability to reason with the physiology and pathophysiology of the human body from visual clues alone causing them to become more emotionally attuned to their patients and aware of their own biases as physicians.

The skills of observation requires improvement and practice from physicians to both diagnose and understand the underlying concerns of a patient. Only when doctors have mastered the art of observation and trained their eyes to truly see, will they ultimately return to a world of greater human connection in medical practice.

References
McKie R. The fine art of medical diagnosis. The Observer. 2011 September 11;Culture. 
Berger L. By Observing Art, Med Students Learn Art of Observation. NY Times. 2001 January 2;Health
Christopher Cook. A Grotesque Old Woman. BMJ 2009;339:b2940
Dequeker J. Benign familial hypermobility syndrome and Trendelenburg sign in a painting “The Three Graces” by Peter Paul Rubens (1577–1640). Annals of the Rheumatic Diseases 2001 September 01;60(9):894-­‐895.
Pecoskie T. Improving patient care with art. The Spec. 2010 December 2;Local. https://www.mcgill.ca/library/files/library/susan_ge_art__medicine.pdf

Categories
Emotion General Medical Humanities Opinion Reflection

Wallflower

Wallflower by Janie Cao
Edited by Mary Abramczuk

Two Novembers ago, I decided to try painting again. At that point, I had been studying medicine for a little over 2 years. After browsing YouTube’s collection of painting tutorials, I found one that seemed realistic for me. It was a still life of roses.

There's a common saying--  "stop and smell the roses." Have you heard of it? It suggests a world that is riddled with roses. I wish that was the world we lived in.

In those years being surrounded by scientific medicine, I think I was learning this: sometimes by the time you arrive, the roses have all been picked. Then it's up to you to create beauty, again, from the ashes.

Wallflower by Janie Cao // 11.24.2016

PC: TonalLuminosity

Categories
Clinical General Opinion Patient-Centered Care Quality Improvement

Notes from a waiting room: What are doctors doing while I’m waiting?

Hello Clinical Laboratory, my old friend,

I’ve come to take my blood test with you again. Because my specialist wants the latest update, so I visit you every 3 months. My appointment was 48 minutes ago, and there are 16 people who arrived earlier than me, still waiting. As the clock ticks, I can hear everything but the sound of silence. Of course you are not alone, Clinical Lab; my other doctors made me wait for them as well. On average, Americans wait 19 minutes and 16 seconds to see a physician, according to Vitals’ Wait Time Report [1]. But the report forgot to add the wait time for check-in at registration and in the examination room. The funny thing about waiting in a clinical laboratory is that a majority of the patients have been fasting before a blood test. So now your patients are not just becoming impatient, but also hungry (or as young people like to call it, “hangry”) as we enter lunchtime.

You offered some reading material to help us pass the time. Many clinics present entertainments like magazines and television to improve the waiting experience [2]. I once visited a fancy clinic that provided an espresso machine for parents and a touchscreen-wall video game for their children. But I have to tell you: I have watched this Judge Judy episode four times in other clinics’ waiting rooms, and I have no desire to touch this well-thumbed Cosmopolitan magazine. Thank you, but, no thanks.

You might wonder why I care about waiting so much. Let me be honest with you: like most of your patients, I compare the waiting time with the time actually spent with the doctor [3]. As patients, if we spend 45 minutes waiting but only get 5 minutes of the doctor’s time, we won’t feel all that waiting was worth it. Certainly, I understand that a vast amount of effort was made behind the scenes. Like the story of Picasso and the bold woman, most people don’t understand that a seemingly effortless one-stroke drawing actually took a lifetime of practice to achieve [4]. I imagine that Dan Ariely and Jeff Kreisler would happily back me up in their book Dollars and Sense: “Assessing the level of effort that went into anything is a common shortcut we use to assess the fairness of the price we’re asked to pay” (in our case, we pay with time).  To solve the problem of customers being reluctant to pay for “invisible effort,” Dan offered the solution of providing transparency [5]. For example, shipping tracking shows all the transactions in each location, and an open-kitchen restaurant shows its staff busy fulfilling food orders. Needless to say, due to medical confidentiality, you can’t have an “open clinic” that shows the staff taking blood pressures or running tests to everyone in the waiting room. But perhaps you could still give us some indication of the “behind the scenes work.” Tell me that you were reading my medical history, that you were double-checking my results, or that you were researching the latest cure. It would make me feel much better to know that you were doing all the “ground work” while I was waiting for you. And I will pretend that I didn’t see you eating bonbons and doing crossword puzzles as I walked past the doctors’ lounge.

And now, I would like to end this letter with a quote from Oscar Wilde’s “The Importance of Being Earnest”:

If you are not too long, I will wait here for you all my life.

Yours truly,

Yi-Lin

 

References:

  1. Vitals wait time report. (2018). Retrieved from https://www.vitals.com/about/wait-time
  2. Ahmad, B., Khairatul, K., & Farnaza, A. (2017). An assessment of patient waiting and consultation time in a primary healthcare clinic. Malaysian Family Physician : The Official Journal of the Academy of Family Physicians of Malaysia, 12(1), 14–21.
  3. Huang, X. (1994). Patient attitude towards waiting in an outpatient clinic and it’s applications. Health service management research. Retrieved from http://journals.sagepub.com/doi/pdf/10.1177/095148489400700101
  4. Airey, D. (2017, September 25). Picasso and pricing your design work. Retrieved from https://www.davidairey.com/picasso-and-pricing-your-work/
  5. Ariely, D., & Kreisler, J. (2017). Dollars And Sense: How We Misthink Money And How To Spend Smarter. Harper

———

Author: Yi-Lin Cheng (website)

Editor: Mary Abramczuk

Image credit: Abraham Solomon, “Waiting for the Verdict” (England. 1859), The J. Paul Getty Museum, via Getty.edu

Categories
Clinical General Healthcare Costs Opinion Patient-Centered Care Reflection

Excellent, good, or fair? How accurately can patient satisfaction surveys measure quality of care?

Last week I had my semiannual dentist appointment. Right after I stepped out the door, I received an email: Dental Office – Patient Satisfaction Survey. Hi, thank you for visiting the dental office. Please take a minute to complete the survey…. Was it a déjà vu? Didn’t I just fill this out recently? Oh wait no. That was for the hygienist? Or was it for that new periodontist? Maybe it was my other specialists?

So besides rating my favorite restaurants and shops on Yelp and Google, now my clinics and insurance companies also want to know how I would rate my doctors– how splendid!

To my surprise, when I clicked the link, the questions were trickier than I expected. According to the email title, it seemed like the survey was about my dentist, but 75% of the questions were about the clinic itself: Waiting time in reception area, appointment phone call answering friendliness, waiting room neatness, office decoration….(Wait…my dentist is responsible for decoration? Great, let’s talk about changing the interior lighting and repainting the wall at the next appointment). As I was filling out the questionnaires, my head started to spin with my own questions: It was a normal checkup appointment, will “fair” be good enough? But I remembered I had given the hygienist an “excellent,” and honestly I couldn’t tell which one was better…oh boy! How are they going to use my answers? Who will be reading my survey responses? Who will be affected by my answers?

To me, it’s difficult to judge the doctors’ performance fairly. I can measure a finance manager by his portfolio performance, a designer by how many designs have been ordered, and a lawyer by how many lawsuits she has won. But judging a doctor is more like judging a piece of artwork: there’s a lot of subjectivity. How do I know Dr. ABC is better than Dr. XYZ? By my test result? Or by the number of medications they prescribe? Like with my dental visit, I couldn’t really tell the difference between that cleaning from the previous ones. Interestingly, some physician groups use patient satisfaction surveys to allocate bonuses [1]. That would make the weight of responsibility seem heavier; I would hate to find out that my dentist lost his Christmas bonus because of my thoughtless answers.

Needless to say, it’s difficult for management to evaluate every department and employee in a large organization. I truly hope that upper management does not blindly rely on this “big data” to determine a doctor’s career path. I would very much like my doctor to focus on my health, instead of for him or her to be driven by monetary incentives and to act as a salesperson. If the survey data is used for allocating the budget, perhaps the survey needs to be transparent about how the clinic is going to use the result: “This survey is for quality training purposes only” or “this survey is for determining the best doctor of the month and who gets the nearest parking spot.” I suspect that knowing the purpose of the survey helps the respondent think twice before jotting down comments or complaints. It might motivate patients to actually finish the survey (I would very much like to meet the saintly soul who is able to finish 30 ambiguous questions without losing their temper). Also, I would like to suggest that since we are giving patients such power, perhaps we can give some power to the physicians too and allow them to rate their patients (like how Airbnb and Uber lets hosts/drivers grade their guests/riders).

Surveys and ratings can be important sources of information. If I need to find a new doctor or specialist, the first thing I do is go on Yelp and sort the list by how many stars they have. Some industries routinely rely on survey systems to improve their customers’ experiences [2].

I understand that the idea behind patient satisfaction surveys is to encourage more communication. But at the end of the day, I believe that the doctor and the patient should have a strong mutual trust that enables them to communicate and give feedback freely and respectfully, without needing to rely on 30 ambiguous survey questions.

 

Reference:

  1. White, B. (1999, January 01). Measuring Patient Satisfaction: How to Do It and Why to Bother. Retrieved April 17, 2018, from https://www.aafp.org/fpm/1999/0100/p40.html
  2. Columbus, L. (2018, April 22). “The State of Digital Business Transformation, 2018.” Retrieved April 25, 2018, from https://www.forbes.com/sites/louiscolumbus/2018/04/22/the-state-of-digital-business-transformation-2018/#761f84535883

Edited by Shaun Webb

Photo credit: Steve Harris

Special thanks to Blog Associate Editor, Janie Cao, for some last-minute content revisions

To learn more about the author, please visit her website here

Categories
Emotion Empathy General Humanistic Psychology Literature Opinion Patient-Centered Care Psychiatry Psychology Public Health Reflection

Book Review: Loose Girl by Kerry Cohen

Hi MSPress Blog Readers!
……
We didn’t have a blog post scheduled for this week, so here’s a book review instead 🙂 I read this book last week for my Adolescent Sexual Health MPH course and enjoyed it.There’s a lot of interesting tidbits on sexual health issues. I mention two.
Even if you don’t agree with everything the author says, I think memoirs can be helpful in showing you unique life perspectives based on true experiences that you may never have experienced yourself. Furthermore, reading memoirs can get you acquainted with potential resources to help others. Ever heard of bibliotherapy, anyone? 🙂
……
Your Blog Associate Editor,
Janie Cao

Categories
General Healthcare Cost Humour Lifestyle Opinion Pharmacology Psychiatry Psychology Public Health Reflection

Well, Well, Well: Products and services compete for shelf space in trendy wellness market, but are they worth your money?

When a friend recently asked me to join them for a class at Inscape, a New York-based meditation studio that New York Magazine described as the “SoulCycle of meditation”, I was skeptical. On the one hand, I usually meditate at home for free, so paying almost $30 for a meditation class seemed a bit silly. On the other hand, my meditation practice had dropped off considerably since the beginning of the year. Maybe an expensive luxury meditation class was just what I needed to get me back into my regular practice. Stepping off bustling 21st Street into the clean modern space, I heard the sounds of, well…nothing. It was incredibly quiet. Before getting to the actual meditation studios, I had to pass through Inscape’s retail space. The minimalistic shelves hold a variety of supplements, tinctures, and powders that include unique ingredients like Reishi medicinal mushrooms and cannabidiol extract. Many contain adaptogens, herbal compounds that purport to increase one’s resistance to stress, though their efficacy has never been quantitatively proven.[1] These products’ promises run the gamut from shiny hair and stress relief to aura cleansing. I may be a super-skeptic, but even I am not immune to the lures of top-notch marketing. With great consideration, I purchased one of the many magical powders for sale labeled as ‘edible intelligence.’

Since wellness has become trendy, a considerable space in the retail market has opened for associated products dedicated to helping people live their best lives. As Amy Larocca pointed out in her June 2017 article The Wellness Epidemic, “[In the wellness world] a loaf of bread may be considered toxic, but a willingness to plunge into the largely unregulated world of vitamins and supplements is a given.” Even a recent episode of Modern Family poked fun at the wellness trend when Haley Dunphy applied for an ultra-competitive job with fictional wellness guru Nicole Rosemary Page. During her interview at Page’s Nerp company headquarters, Page laments, “People say that Nerp is nothing more than a con-job, a cash grab vanity project from a kooky actress. I want to turn Nerp into the next Disney-Facebook-Tesla-Botox. It’s a world changer.” Though Page is a fictional character, I can’t help but wonder whether the character was inspired by the very real Amanda Chantal Bacon, the founder of Moon Juice, which bills itself as an adaptogenic beauty and wellness brand. Bacon’s Moon Dusts retail for $38 a jar and come in varieties such as Spirit, Beauty, and Dream.

The bottom line is that a sense of well-being needn’t come at the price of thirty-plus dollars an ounce. In fairness to those who choose to spend lavishly, I believe that plunking down a chunk of cash might create an intention to use and derive value from a product, thus positively influencing one’s perception of how well the product works. Rest assured, however, that living with intention and gratitude can be just as easily accomplished without spending any money at all. Carving out time in the day to create a small ritual for yourself can be as simple as spending a few minutes in the morning listening to jazz as you drink your first cup of coffee or allowing yourself to become immersed in a good book before drifting off to sleep. These simple acts allow us to bestow kindness upon ourselves that is especially important in our stressful and busy lives as medical students. My suspicion is that by performing such rituals with intention, we derive much of the same benefit whether our mug is filled with the trendy mushroom coffee or just plain old Folgers.

I’m always thinking about ways I can improve my own well-being, but as graduation approaches I also find myself thinking about how these practices might help my patients as well. One of my fundamental goals as a future psychiatrist will be to help my patients see the value in themselves and in their own lives. I predict that for many of my patients, achieving this goal will depend perhaps on medications but also on the deployment of simple wellness tactics such as I described. I’m not going to lie…I’m still intrigued by many of the wellness products that can be found in places like Inscape, Whole Foods, and the Vitamin Shoppe, especially when I think about the potential benefits they might have for my future patients. I figure that if these products do even half of what they promise to, some of them might even be worth the money. So what happened when I added a sachet of intelligence powder to my usual morning smoothies? Pretty much nothing. At one point, I got excited when I began to feel my fingers getting tingly. Then I realized I had been leaning on my ulnar nerve. Not so brainy after all.

[1] Reflection Paper on the Adaptogenic Concept, Committee on Herbal Medicine Products of the European Medicines Agency, May 2008.

 

Photo credit: Open Grid Scheduler / Grid Engine

Categories
Clinical General Healthcare Costs Law Opinion Patient-Centered Care Primary Care Public Health Reflection

Discontinuity in Care

My resident tries fairly hard to take care of his patients. When he is with them, I catch him paying attention to all sorts of details that he could have easily let slip past. So it made it all the more difficult when I saw him enraged. When he opened up his list of clinic appointments one morning, on the list was a patient he did not want to see. It was not just that she was a new patient to him. It was not just that her problem list went on like a run-on sentence. It was that both were true, and my resident was still expected to see her in only 15 minutes.

While chart reviewing, he learned that the only consistency in this patient’s medical care at our clinic had been a history of inconsistent providers—and based on their notes, none of them had the complete story. “Why am I even seeing her?!” my resident asked rhetorically, as he frantically searched for answers he knew he did not have the time to find. I wondered, too. This visit seemed to benefit no one except the Billing Department, and even that would depend on whether the Medicare reimbursements actually made it through.

That patient’s experience was hardly unique, though. While rotating through various specialties as a medical student, I have met several patients who were passed from one provider to another. Maybe the provider had to switch services. Maybe they left the institution for better opportunities elsewhere. The reasons were myriad. Stories like those suggest that continuity of care may still only be a priority in primary care literature.

I think one reason for this reality is a lack of incentives to keep doctors and patients together. In any field, including medicine, we see money driving people’s attention and vice versa. Since our country has historically kept primary care on the back burner, there is little evidence to believe that practical incentives for continuity of care will spontaneously appear in the near future.

So, for the primary care fans out there, it might be worth it to start speaking up.

 

Photo credit: Norbert von der Groeben/Stanford School of Medicine, posted by National Center for Advancing Translational Sciences

Categories
General Opinion Public Health Reflection

Feminine Hygiene: My Own Struggle at the Airport

Surrounding me in the Barcelona airport this past winter was the latest technology—new scanners and gadgets directed at catching radioactive and explosive material more quickly and safely than before. Large plasma screen TVs were on every corner, and numerous retail shops caught my eye at every glance. With an expansive collection of restaurants and shops, one would think this is more of a mall than an airport. Given the mini-mall appearance, I felt I would have no trouble finding a place to purchase a tampon or pad, as Mother Nature had unexpectedly paid me a visit and I was unprepared. After first checking the bathroom for a tampon dispenser and finding none, I went from store to store looking for a personal hygiene section. To my dismay, there were an assortment of shaving creams and toothbrushes and even diapers, but there were no tampons or pads to be found. After scanning all the stores in my immediate vicinity, I decided to inquire at the cashier desk, which was occupied by a female clerk. When I asked her about where I could potentially find some feminine hygiene products, she informed me that I was out of luck. Her and other female colleagues all kept tampons and pads in their bags because there was no place to purchase them in the area. Fortunately for me, they kindly provided me with a few from their stash for my long journey home.

While this may be expected in a less developed area with few resources, an airport that boasts being “among the top 30 busiest airports in the world”1 should have several places to purchase feminine hygiene products. I was incredulous that an airport outside a major hub in Europe in the 21st century had no place for female employees or travelers to purchase a pad or tampon. This is an issue that must be corrected—whether by adding tampon dispensaries or vending machines, or simply by increasing inventory in the numerous retail shops lining the terminals. The Barcelona airport, along with any other major public areas that are traversed daily, should be required to carry these products.

While I was fortunate enough to receive some aid from the female clerks at one of the retail shops, I know there have been many other women who have been inconvenienced by either lack of menstrual products or their cost. In the same month, another traveler at the Calgary YYC airport reported that she had to pay a whopping $15 for a box of tampons at the airport2. Of course, it is a known fact that prices in the airport are always much higher than in retail shops outside – same goes for museum gift shops and others located near tourist attractions. However, for a product that is a basic hygienic necessity for half of the globe’s population, it is prejudicial that it is also priced almost double what it is in a regular grocery store. That traveler’s post sparked a global dialogue as to why these products are not easily found or are not affordable in places that millions of women work or travel.

While a dialogue is an important start, we need to continue to bring this issue into the spotlight. No woman in 2018 should be forced to pay egregious prices for basic hygiene and even more importantly, there should be access to feminine hygiene products in all institutions, including schools, airports, and workplaces.

Source(s):

1https://www.barcelona-airport.com/eng/information.php

2http://www.metronews.ca/news/calgary/2017/12/04/viral-post-blasts-tampon-price-gouging-at-yyc-airport.html

Photo credit: Sor Cyress Source: Flickr