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.

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.

Reprise – David Buck, Caring for High-Need, High-Cost Patients

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This week, Thomas Kim hosts the show and interviews Dr. David Buck, a family physician and professor of family and community medicine at the Baylor College of Medicine.  He is the founder and president of Patient Care Intervention Center (PCIC), an organization that uses advanced population health methods to target super-utilization of the health care system and intervenes through intensive care coordination and case management. It’s based in Houston, Texas and recently opened a branch in Dallas, and they were recently featured on PBS NewsHour. Prior to Dr. Buck’s work at PCIC, he founded Healthcare for the Homeless – Houston (HHH), now a federally qualified health center for over 7,000 homeless in Harris County, as well as the associated Houston Outreach Medicine Education and Social Services (HOMES) clinic, a student-managed clinic at HHH in conjunction with BCM and the University of Texas Health Science Center. He is a co-founder of the Houston-based physician advocacy group Doctors for Change, and founded the Houston-Galveston Albert Schweitzer Fellowship. He helped found the international street medicine institute, and was appointed to the 15-member Consumer Operated and Oriented Plan Program advisory board created as part of the Patient Protection and Affordable Care Act in 2012.

You can find some CDC resources about Adverse Childhood Experiences, or ACEs here, and a New Yorker article about the effects of ACEs on health here.
Dr. Buck is a graduate of the Baylor College of Medicine and the University of Texas School of Public Health, as well as family medicine residency at the University of Rochester.

Reprise – Natalie Spicyn, Unionizing Clinicians

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This week we are joined by Natalie Spicyn, an internist and pediatrician at Chase Brexton, a Federally Qualified Community Health Center in Baltimore. Like all FQHCs, Medicaid patients are a large portion of the Chase Brexton payor mix, but the clinic also provides specialized care for a large and active LGBT and HIV positive community in the city.  Last year, caregivers and administrators faced conflict regarding proposed workflow, volume, and compensation restructuring. Several employees were terminated during early efforts at unionization; ultimately, clinicians voted to unionize and attempt collective bargaining.  Natalie published an op-ed in the Baltimore Sun during this tumultuous period, and joins us to talk about her experiences with unionizing, fair compensation practices in primary care, and how all of this affects patient care.

Photo: Rally outside Chase Brexton Health Care in Baltimore, Maryland, on Aug. 19, 2016. Photo: Jay Mallin, jay@jaymallinphotos.com, Courtesy of 1199 SEIU

Lauren A Taylor – Integration of Healthcare and Social Services

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Today we’re joined by Lauren A Taylor, a health services researcher based at Harvard Business School, where is she is earning her doctorate in health policy and management. Prior to joining HBS, Lauren co-authored The American Health Care Paradox, which has become required reading at a variety of medical and public health schools across the country. Our discussion spans a range of topics and should excite clinician and policymaker listeners alike, especially those interested in addressing upstream factors that affect health in our American society.

We start with reviewing the initial research paper that lay the groundwork for her book and what other countries show us about how government spending on social services can affect health outcomes, as well as what she learned interviewing caregivers and social services workers in the US.  We also talk on how American sociopolitical factors influence our discourse on the distribution and allocation of resources as well as how research is done in her field. We discuss whether health systems are moving in the right direction addressing social determinants of health through ACOs, why management gets overlooked and undervalued as a key ingredient in healthcare delivery, and why it’s just so hard to get all of this right.

Lauren’s work focuses on organizational theory and strategy in health care, with a particular emphasis on the integration of health and social services. She holds a BA in the History of Medicine and a Master in Public Health from Yale University. She has also worked as a health care chaplain and studied ethics as a Presidential Scholar at Harvard’s Divinity School.

If you like the show, please subscribe on our website www.rospod.org, and rate us on iTunes and Stitcher and share us on social media. Get in touch via twitter @RoSpodcast or drop us a line at contact@rospod.org. Thanks for listening!

Lisa Sanders – Patient Stories & Zebras

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This week, we are joined by Lisa Sanders. You may recognize her name from the monthly “Diagnosis” column that she writes for the New York Times Magazine. She writes about unusual cases and diagnostic dilemmas, exploring both a patient’s experience of disease but also their journey through the healthcare system. She is the author of a book exploring similar themes, Every Patient Tells a Story. Her column was the inspiration for the popular TV show House, and she served as a technical advisor for the show. Dr. Sanders is an associate professor of medicine and a clinician educator in the primary care internal medicine residency program at Yale University School of Medicine.

Today, we talk about her journey in medicine, going from outsider to insider in medicine, and using English rather than medicalese. She talks about what it is like to live in a world of zebras when most of us are used to horses, and how she finds her fantastic cases. Lastly, she shares what it is like to work as a technical advisor on a hit TV show.

Send your interesting cases to Dr. Sanders for her column: lisa.sandersmdATgmail.com.

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.

Dennis Dimitri – Supervised Injection Facilities

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Today we are joined by Dr. Dennis Dimitri, the immediate past-president of the Massachusetts Medical Society (MMS) and current chair of the society’s Task Force on Opioid Prescribing and Physician Communication, to discuss supervised injection facilities, or SIFs. A SIF is a location where individuals may use illegal drugs under the supervision of a medical professional ready to assist in case of an overdose requiring treatment.

Later this month, the MMS will vote on whether to advocate for a task force to assess the feasibility of a pilot SIF in the state of Massachusetts. If the proposal is approved, the MMS will become the first statewide physician organization in the Bay State to advocate for such a pilot program.

We discuss with Dr. Dimitri what it would mean should the MMS advocate for SIFs. We review the evidence on the effect of SIFs on rates of fatal overdoseuptake of Substance Use Disorder treatment, and rates of transmission of HIV and HCV. We talk about the ethical considerations of such a program, whether SIFs enable behaviors harmful to people’s health or they represent harm reduction, and the complex legal considerations involved with a potential pilot program.

Major events of the opioid epidemic in the last few years, such as business owners planning for the possibility of overdose in bathrooms and a recent HIV outbreak stemmed by a needle exchange program in Indiana, raise the potential benefits of SIFs. If you’re interested in reading more, check out recent guest Dr. Sarah Wakeman‘s compassionate and evidence-based case for SIFs in this recent NEJM article. You can also listen to our past episode Dr. Jessie Gaeta on the SPOT program (supportive place for observation and treatment) when she also gave her thoughts on SIFs.

Dr. Dimitri is a family physician and Vice Chair of the Department of Family Medicine at University of Massachusetts and the UMass Memorial Medical Center.

What do you think? In the face of the opioid epidemic, could pilot SIFs in the US also reduce overdose deaths as in Canada and Australia? Tweet us your thoughts at @rospodcast or leave a comment on our facebook page at www.facebook.com/reviewofsystems.  Or, drop us a line directly at contact@rospod.org. We’d love to hear from you – and thanks for listening.

Graphic from of Centers for Disease Control, Opioid Overdose.