Joshua Freeman – Designing a Fair & Equitable Healthcare System

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Dr. Joshua Freeman is a family physician, health policy researcher, social justice activist, and writer.  He publishes a widely-read blog, “Medicine and Social Justice”, and in 2015 published a book, Health, Medicine and Justice: Designing a fair and equitable healthcare system (Copernicus Healthcare press), which is available on Amazon and other sites, in both softcover and electronic versions.

This week, Thomas Kim chats with Dr. Freeman about some of the major themes of the book: why the US health care system fails to produce a healthy population, the role of profit in American medicine, why he uses social justice to frame his analyses and commentary, and how the American health care system could become more primary care-centered.

Dr. Freeman is Professor Emeritus at the University of Kansas Medical Center in Kansas City, where he served as the Alice M. Patterson MD and Harold L. Patterson MD Professor and Chair of the Department of Family Medicine from 2002-2016, and was also Professor in the Departments of Preventive Medicine and Public Health and of Health Policy and Management. He was a Fulbright Scholar in São Paulo, Brazil in 2003 and served nationally as Treasurer of the Society of Teachers of Family Medicine and the Association of Departments of Family Medicine. He received STFM’s highest honor, the Recognition Award, in 2006. He served as a member of the board of trustees of Roosevelt University in Chicago, as assistant editor of the journal Family Medicine, and also on the board of Southwest Boulevard Family Health Center in Kansas City, KS.

Dr. Freeman is a graduate of the Loyola-Stritch School of Medicine, family medicine residency at Cook County Hospital in Chicago, and faculty development fellowship and Preventive Medicine residency at the University of Arizona.

This interview was lightly edited for clarity.

Journal Club – Exploring the Patient and Staff Experience with the Process of Primary Care

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This week, we bring you a journal club on the manuscript: Exploring the Patient and Staff Experience with the Process of Primary Care, which was published in Annals of Family Medicine in the July/August 2015 issue by Elizabeth J Brown, Shreya Kangovi, Christopher Sha, Sarah Johnson, Casey Chanton, Tamala Carter, and David Grande.

If you like the show, please rate and review us on itunes, google play, stitcher or your favorite podcasting app, which makes the show easier for others to find; and share us on social media. We tweet at @RoSpodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

How to Prevent Burnout with Diane Shannon & Paul DeChant

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This week, in the second of our series about physician burnout, our guests focus on solutions. Diane Shannon and Paul DeChant, both physicians, join us to talk about their recent book Preventing Physician Burnout, Curing the Chaos and Returning Joy to the Practice of Medicine.

Diane and Paul talk about their experiences with burnout and how they came to work on this project together, how they contend that organizational and structural factors are more important than individual factors in driving burnout, how compensation and intangible rewards can reduce burnout, how leadership in healthcare can address the epidemic of burnout. We also talk about how they have come to believe that the LEAN principles, most especially the pillar of respect for people, is key in transforming healthcare organizations into places where primary care physicians can thrive, why change is so difficult, and some other resources that can help.

Diane Shannon is a general internist who left clinical medicine due to burnout and turned to a career in medical writing and public health. Paul DeChant is a family physician and experienced healthcare executive who has previously worked in organizations such as The Paulo Alto Medical Foundation, Sutter Gould Medical Foundation, and is now a senior advisor with Simpler Healthcare.

If you’ve missed it, have a listen to the first in our burnout series with Colin West, researcher at Mayo Clinic who has done foundational research on burnout and physician well-being. Please rate and review us on itunes, google play, or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you, and thanks for listening.

Colin West – The Evidence Behind Burnout

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This week, we are joined by Colin West, professor of Medicine, Biostatistics and Medical Education at Mayo Clinic. Colin’s research focuses primarily on physician well-being, evidence based medicine and medical education. We talk today about his extensive research in the area of physician well-being and burnout.

We talk about what researchers mean precisely by burnout and how it is measured, what the implications are for patient care and quality of care that the primary care workforce is increasingly burdened with burnout, and his findings in an important 2016 study that physicians with significant burnout scores cut back on patient care over time. We also talk about the EMR, and what specific features of EMR most correlate with user dissatisfaction. Lastly, we talk about what questions he most wants to answer in his field. This is part 1 of a 2-part series on burnout. Today we focus on the evidence behind burnout, and in part 2 we will talk about what can be done to alleviate the problem.

If you like the show, please rate and review us on itunes, google play, or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you, and thanks for listening.

David Himmelstein – Blending Research & Advocacy

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Our guest this week is David Himmelstein. He is a distinguished professor of public health and health policy in the CUNY School of Public Health at Hunter College, adjunct clinical professor at Albert Einstein College of Medicine, and lecturer in medicine at Harvard Medical School. He has served as chief of the division of social and community medicine at Cambridge Hospital.

David has authored or co-authored more than 100 journal articles and three books, including widely cited studies of medical bankruptcy and the high administrative costs of the U.S. health care system. His 1984 study of patient dumping led to the enactment of EMTALA, the law that banned that practice. He is also a co-founder of Physicians for a National Health Program and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. Steffie Woolhandler.

We talk about how he got his start in research by looking at patient dumping practices as a trainee, and how he views advocacy as a natural outgrowth of his research findings. We also talk about his work as a leader in advocacy for a national health insurance program and talk about a few common arguments against such policy changes. Lastly, he gives some advice for folks early in their career who would like to follow his model of research blended with advocacy.

If you like the show, please rate and review us on itunes, google play, or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you, and thanks for listening.

Journal Club – Do On-Site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems?

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On our journal club this week, we talk about an article published in September 2016 in the journal Academic Pediatrics: Do On-Site Mental Health Professionals Change Pediatricians’ Responses to Children’s Mental Health Problems? By Sarah McCue Horwitz and colleagues.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Gail D’Onofrio, Initiation of Suboxone Treatment for Opiate Use Disorder in the ED

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This week we are again looking at the opioid crisis, but this time from the perspective of an emergency room physician. Gail D’Onofrio, MD, MS is Physician-in Chief of Emergency Services at Yale-New Haven Hospital; she and her colleagues published a randomized controlled trial in JAMA in April 2015 looking at an intervention initiating suboxone treatment for patients with substance use disorders in the ED.  Gail is Professor and Chair of the Department of Emergency Medicine at Yale University and is internationally known for her work in substance use disorders, women’s cardiovascular health, and mentoring physician scientists in research careers, and she is a founding board member of the American Board of Addiction Medicine.

We talk about her perspective on the opioid epidemic as an ED physician; her RCT; how people could set up a similar program in their local ED and community; and her thoughts on ED utilization for primary care complaints, which is the subject of a recently issued report from the Massachusetts Health Policy Commission.

Please rate and review us on iTunes or Stitcher and share us on social media. Tweet us your thoughts @RoSpodcast and check out our Facebook page at www.facebook.com/reviewofsystems. Or, you can email us at contact@rospod.org. We’d love to hear from you.

Harold Pollack – ACA and AHCA Update

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This week we are joined a few days early by Harold Pollack to bring you a timely update on the Affordable Care Act (ACA) repeal and American Health Care Act (AHCA) legislation that is moving quickly through congress.

Harold has published widely at the interface between poverty policy and public health including the effects of health reform and the ACA. Today we talk about the current state of the repeal and replace effort in the Senate and what effects their bill would have in terms of individuals who would lose coverage or find it much more expensive should the bill pass. We also discussed the very dramatic changes the bill would likely make to Medicaid and how that might affect the poor and vulnerable people that the program serves, and in particular how it might impact the raging opiate epidemic. Lastly, we talk about what a bipartisan solution to many of the very real problems of the ACA might look like, and what impact individuals can have on policy by calling congress. You can find more information about the unusual legislative process here, and the lack of information available on the bill here. Read about the effects that changes to Medicaid might make for disabled individuals here, and listen to Matt Broaddus of the Center on Budget and Policy Priorities discuss block granting and per capita caps on Medicaid here. If you would like to reach out to your Senator to talk with him or her about the legislation and how it might affect you or your patients, you can find your Senator’s contact information here.

Harold is the Helen Ross Professor at the School of Social Service Administration, an Affiliate Professor in the Biological Sciences Collegiate Division and the Department of Public Health Sciences and Co-Director of The University of Chicago Crime Lab and a committee member of the Center for Health Administration Studies (CHAS) at the University of Chicago. He tweets @haroldpollack.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Bon Ku – Design Thinking in Healthcare

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This week we are joined by Bon Ku, the Assistant Dean for Health and Design and an Associate Professor at the Sidney Kimmel Medical College at Thomas Jefferson University, to talk about design thinking and medicine. Bon is a practicing emergency medicine physician and the founder and director of JeffDESIGN, a first-of-its-kind program in a medical school that teaches future physicians to apply human-centered design to healthcare challenges. Bon has spoken widely on the intersection of health and design thinking (TEDx, South by Southwest, Mayo Clinic Transform, Stanford Medicine X, Association of Collegiate Schools of Architecture) and serves on the Design and Health Leadership Group at the American Institute of Architects. Bon talks with us about what design thinking is, how he got into it, why he thinks physicians would benefit from learning to think in this way, and how to apply it to common primary care challenges, like walk-ins. He also directs listeners to the following resources to learn more about design thinking in medicine: the Stanford Dschool, and ideou.

If you like the show, please rate and review us on itunes or stitcher, which makes the show easier for others to find; and share us on social media. We tweet at @rospodcast and are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Journal Club – Los Angeles Safety Net Program eConsult System Was Rapidly Adopted and Decreased Wait Times to See Specialists

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For this week’s journal club, we are talking about a recent paper from Health Affairs entitled: Los Angeles Safety Net Program eConsult System Was Rapidly Adopted and Decreased Wait Times to See Specialists  by Michael Barnett, Hal F. Yee Jr, Ateev Mehotra, and Paul Giboney. The paper describes and analyzes data from an e-consult system that was rolled out to a network of hundreds of safety-net clinics in Los Angeles County. We are thrilled to have the lead author, Michael Barnett, join us for our discussion! Michael is an Assistant Professor at Harvard T.H. Chan School of Public Health and a primary care physician at Brigham and Women’s Hospital. He publishes prolifically on a variety of topics, and is particularly interested in the primary care-specialty care interface.

Do you use e-consults in your practice? Or do you wish you had access to such a system? Please tweet us your thoughts @RoSpodcast, or drop us a line at contact@rospod.org. And, let us know what manuscripts you think we should look at in future journal clubs or who we should have on to talk about their work. We look forward to hearing from you, and thanks for listening.